Provider Demographics
NPI:1932224086
Name:SURE CARE HEALTH CARE SERVICES
Entity Type:Organization
Organization Name:SURE CARE HEALTH CARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CARMELO
Authorized Official - Middle Name:RUIZ
Authorized Official - Last Name:MEDINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-859-7606
Mailing Address - Street 1:1109 W SAN BERNARDINO RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91722-4163
Mailing Address - Country:US
Mailing Address - Phone:626-859-7606
Mailing Address - Fax:626-859-7604
Practice Address - Street 1:1109 W SAN BERNARDINO RD
Practice Address - Street 2:SUITE 200
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91722-4163
Practice Address - Country:US
Practice Address - Phone:626-859-7606
Practice Address - Fax:626-859-7604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHHA57755FMedicaid
CAHHA57755FMedicaid
CA557755Medicare ID - Type Unspecified