Provider Demographics
NPI:1174736342
Name:GENE CARE INC.
Entity type:Organization
Organization Name:GENE CARE INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:GODLEWSKA
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:909-623-7000
Mailing Address - Street 1:4657 ELLENITA AVE
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-4931
Mailing Address - Country:US
Mailing Address - Phone:909-618-6167
Mailing Address - Fax:818-881-4983
Practice Address - Street 1:324 PALOMA DR
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-5620
Practice Address - Country:US
Practice Address - Phone:909-623-7000
Practice Address - Fax:909-623-7041
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GENE CARE, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-07
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAADU70405FOtherPROVIDER NUMBER