Provider Demographics
NPI:1831543818
Name:CARE OPTIONS ONE
Entity type:Organization
Organization Name:CARE OPTIONS ONE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:C.A.LICENSED PROGRAM ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:I
Authorized Official - Last Name:IMOESIRI
Authorized Official - Suffix:
Authorized Official - Credentials:BA,RNA
Authorized Official - Phone:818-629-8678
Mailing Address - Street 1:12632 CROSSDALE AVE
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CA
Mailing Address - Zip Code:90650-2671
Mailing Address - Country:US
Mailing Address - Phone:818-629-8678
Mailing Address - Fax:
Practice Address - Street 1:439 ROBINSON DR
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92782-0907
Practice Address - Country:US
Practice Address - Phone:818-629-8678
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-16
Last Update Date:2016-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6031197740305R00000X, 311ZA0620X, 320700000X, 315D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315D00000XNursing & Custodial Care FacilitiesHospice, Inpatient
No305R00000XManaged Care OrganizationsPreferred Provider Organization
No311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
No320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities