Provider Demographics
NPI:1366869042
Name:CORECONCLUSIVE CARE INC
Entity type:Organization
Organization Name:CORECONCLUSIVE CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROLANDO
Authorized Official - Middle Name:
Authorized Official - Last Name:SAN GABRIEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-391-6452
Mailing Address - Street 1:615 N EUCLID AVE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91762-3200
Mailing Address - Country:US
Mailing Address - Phone:909-391-6452
Mailing Address - Fax:909-391-6426
Practice Address - Street 1:615 N EUCLID AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91762-3200
Practice Address - Country:US
Practice Address - Phone:909-391-6452
Practice Address - Fax:909-391-6426
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-19
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based