Provider Demographics
NPI:1043891807
Name:CANDLEBERRY CARE
Entity type:Organization
Organization Name:CANDLEBERRY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ULDARICO
Authorized Official - Middle Name:
Authorized Official - Last Name:ALMIRANEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-290-6006
Mailing Address - Street 1:4216 CANDLEBERRY AVE
Mailing Address - Street 2:
Mailing Address - City:SEAL BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90740-2825
Mailing Address - Country:US
Mailing Address - Phone:949-290-6006
Mailing Address - Fax:
Practice Address - Street 1:4216 CANDLEBERRY AVE
Practice Address - Street 2:
Practice Address - City:SEAL BEACH
Practice Address - State:CA
Practice Address - Zip Code:90740-2825
Practice Address - Country:US
Practice Address - Phone:949-290-6006
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-14
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA306005780OtherDSS CCLD