Provider Demographics
NPI:1881745487
Name:COORDINATED CARE CENTER INC.
Entity type:Organization
Organization Name:COORDINATED CARE CENTER INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:ERWIN
Authorized Official - Last Name:CABLAYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-521-9641
Mailing Address - Street 1:6812 OAK AVE
Mailing Address - Street 2:
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91775-2030
Mailing Address - Country:US
Mailing Address - Phone:626-446-5263
Mailing Address - Fax:626-446-8109
Practice Address - Street 1:6812 OAK AVE
Practice Address - Street 2:
Practice Address - City:SAN GABRIEL
Practice Address - State:CA
Practice Address - Zip Code:91775-2030
Practice Address - Country:US
Practice Address - Phone:626-446-5263
Practice Address - Fax:626-446-8109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9500092314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZT18606GMedicaid
CAZZT18606GMedicaid