Provider Demographics
NPI:1982470134
Name:TELECARE RIDGECREST CSU
Entity Type:Organization
Organization Name:TELECARE RIDGECREST CSU
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LVN
Authorized Official - Prefix:
Authorized Official - First Name:NATASHA
Authorized Official - Middle Name:SOPHIE
Authorized Official - Last Name:CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:LVN
Authorized Official - Phone:626-393-8666
Mailing Address - Street 1:1141 CHELSEA ST
Mailing Address - Street 2:
Mailing Address - City:RIDGECREST
Mailing Address - State:CA
Mailing Address - Zip Code:93555-3208
Mailing Address - Country:US
Mailing Address - Phone:760-463-2880
Mailing Address - Fax:
Practice Address - Street 1:1141 CHELSEA ST
Practice Address - Street 2:
Practice Address - City:RIDGECREST
Practice Address - State:CA
Practice Address - Zip Code:93555-3208
Practice Address - Country:US
Practice Address - Phone:760-463-2880
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-29
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164X00000XNursing Service ProvidersLicensed Vocational NurseGroup - Multi-Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental HealthGroup - Multi-Specialty