Provider Demographics
NPI:1528735677
Name:CERRITOS RESIDENCE CARE INC.
Entity type:Organization
Organization Name:CERRITOS RESIDENCE CARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:NORA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-778-3949
Mailing Address - Street 1:13548 REVA PL
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-8921
Mailing Address - Country:US
Mailing Address - Phone:714-778-3949
Mailing Address - Fax:
Practice Address - Street 1:13548 REVA PL
Practice Address - Street 2:
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90703-8921
Practice Address - Country:US
Practice Address - Phone:714-778-3949
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CERRITOS RESIDENCE CARE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-08-26
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility