Provider Demographics
NPI:1861102519
Name:OBEA SENIOR LIVING LLC
Entity type:Organization
Organization Name:OBEA SENIOR LIVING LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:KOFI
Authorized Official - Last Name:ASARE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-779-2288
Mailing Address - Street 1:765 NORTH MAIN STREET
Mailing Address - Street 2:#150
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92878
Mailing Address - Country:US
Mailing Address - Phone:949-779-2288
Mailing Address - Fax:949-393-0013
Practice Address - Street 1:765 NORTH MAIN STREET
Practice Address - Street 2:#150
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92878
Practice Address - Country:US
Practice Address - Phone:949-779-2288
Practice Address - Fax:949-393-0013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-02
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA304700327OtherHOME CARE ORGANISATION NUM