Provider Demographics
NPI:1487791216
Name:CAREMERIDIAN, LLC
Entity type:Organization
Organization Name:CAREMERIDIAN, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-688-5251
Mailing Address - Street 1:163 TECHNOLOGY DR STE 200
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-2486
Mailing Address - Country:US
Mailing Address - Phone:949-794-0787
Mailing Address - Fax:949-266-8679
Practice Address - Street 1:11500 CENTER AVE
Practice Address - Street 2:
Practice Address - City:GILROY
Practice Address - State:CA
Practice Address - Zip Code:95020-9223
Practice Address - Country:US
Practice Address - Phone:408-686-0758
Practice Address - Fax:408-686-0618
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NATIONAL MENTOR HEALTHCARE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-31
Last Update Date:2019-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA070000603313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHCB00004FMedicaid
CA070000603OtherSTATE DHS LICENSE #