Provider Demographics
NPI:1700094919
Name:CARIDEAN, INC.
Entity type:Organization
Organization Name:CARIDEAN, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:LICENSEE
Authorized Official - Prefix:
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIFFIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-770-2051
Mailing Address - Street 1:1948 THOREAU ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90047-4725
Mailing Address - Country:US
Mailing Address - Phone:323-770-2051
Mailing Address - Fax:
Practice Address - Street 1:8630 RAYFORD DR
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045-3512
Practice Address - Country:US
Practice Address - Phone:323-779-2051
Practice Address - Fax:323-779-3615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-19
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA960000944315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities