Provider Demographics
NPI:1447840715
Name:ABOVE AND BEYOND CARE PROVIDERS,INC.
Entity type:Organization
Organization Name:ABOVE AND BEYOND CARE PROVIDERS,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PATRIA
Authorized Official - Middle Name:MARAVILLA
Authorized Official - Last Name:DUFRENNE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:310-521-9896
Mailing Address - Street 1:2300 S PACIFIC AVE
Mailing Address - Street 2:
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90731-5936
Mailing Address - Country:US
Mailing Address - Phone:310-521-9896
Mailing Address - Fax:310-684-5490
Practice Address - Street 1:2300 S PACIFIC AVE
Practice Address - Street 2:
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90731-5936
Practice Address - Country:US
Practice Address - Phone:310-521-9896
Practice Address - Fax:310-684-5490
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ABOVE AND BEYOND CARE PROVIDERS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-01-21
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility