Provider Demographics
NPI:1912950932
Name:JOHNRE CARE LLC
Entity Type:Organization
Organization Name:JOHNRE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHNNY
Authorized Official - Middle Name:
Authorized Official - Last Name:SICAT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-313-5685
Mailing Address - Street 1:16162 PONDEROSA LN
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92504-6155
Mailing Address - Country:US
Mailing Address - Phone:951-780-5348
Mailing Address - Fax:951-780-5348
Practice Address - Street 1:461 E JOHNSTON AVE
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92543-7113
Practice Address - Country:US
Practice Address - Phone:951-658-6374
Practice Address - Fax:951-658-5263
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA055401Medicare ID - Type UnspecifiedMEDICARE PROVDER NUMBER