Provider Demographics
NPI:1952538936
Name:UNITED CARE HOMES - PURE JOY #2
Entity type:Organization
Organization Name:UNITED CARE HOMES - PURE JOY #2
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSEE
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSANA
Authorized Official - Middle Name:CRUZ
Authorized Official - Last Name:TUBIANOSA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:626-810-5567
Mailing Address - Street 1:1982 CAMWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:ROWLAND HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:91748-4044
Mailing Address - Country:US
Mailing Address - Phone:626-810-5567
Mailing Address - Fax:626-810-4910
Practice Address - Street 1:14944 LINDHALL WAY
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90604-1553
Practice Address - Country:US
Practice Address - Phone:562-946-4784
Practice Address - Fax:626-810-4910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-17
Last Update Date:2009-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA960000580315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities