Provider Demographics
NPI:1831632462
Name:SOUTHERN CALIFORNIA HEALTH CARES
Entity type:Organization
Organization Name:SOUTHERN CALIFORNIA HEALTH CARES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER - CEO
Authorized Official - Prefix:
Authorized Official - First Name:LESTER
Authorized Official - Middle Name:GERALD
Authorized Official - Last Name:SPOELSTRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-747-5801
Mailing Address - Street 1:415 TENNESSEE ST
Mailing Address - Street 2:SUITE U
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-8168
Mailing Address - Country:US
Mailing Address - Phone:909-747-5801
Mailing Address - Fax:909-335-0494
Practice Address - Street 1:13909 1/2 AMAR RD
Practice Address - Street 2:
Practice Address - City:LA PUENTE
Practice Address - State:CA
Practice Address - Zip Code:91746-3601
Practice Address - Country:US
Practice Address - Phone:626-814-3140
Practice Address - Fax:626-814-3294
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-30
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA060000614261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA112424664OtherMEDICAID