Provider Demographics
NPI:1881050185
Name:121 CARE LLC
Entity type:Organization
Organization Name:121 CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:PEDTKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:650-873-6695
Mailing Address - Street 1:424 9TH ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94103-4411
Mailing Address - Country:US
Mailing Address - Phone:855-572-0400
Mailing Address - Fax:
Practice Address - Street 1:424 9TH ST
Practice Address - Street 2:SUITE 200
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94103-4411
Practice Address - Country:US
Practice Address - Phone:855-572-0400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIM INNOVATIONS, INC SOLE MBR
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-01-04
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier