Provider Demographics
NPI:1255795977
Name:TANNER CARE, LLC
Entity type:Organization
Organization Name:TANNER CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:COMPTON
Authorized Official - Last Name:LAMB
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:626-471-9710
Mailing Address - Street 1:825 S MYRTLE AVE
Mailing Address - Street 2:
Mailing Address - City:MONROVIA
Mailing Address - State:CA
Mailing Address - Zip Code:91016-3424
Mailing Address - Country:US
Mailing Address - Phone:626-471-9710
Mailing Address - Fax:626-471-9800
Practice Address - Street 1:825 S MYRTLE AVE
Practice Address - Street 2:
Practice Address - City:MONROVIA
Practice Address - State:CA
Practice Address - Zip Code:91016-3424
Practice Address - Country:US
Practice Address - Phone:626-471-9710
Practice Address - Fax:626-471-9800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-08
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center