Provider Demographics
NPI:1861726457
Name:CHERRYCARE AT-HOME, LLC
Entity type:Organization
Organization Name:CHERRYCARE AT-HOME, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:STAN
Authorized Official - Middle Name:K
Authorized Official - Last Name:CHING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-342-4377
Mailing Address - Street 1:1448 LEXINGTON ST
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92782-1778
Mailing Address - Country:US
Mailing Address - Phone:877-342-4377
Mailing Address - Fax:
Practice Address - Street 1:1448 LEXINGTON ST
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92782-1778
Practice Address - Country:US
Practice Address - Phone:877-342-4377
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CCSC PARTNERS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-09-29
Last Update Date:2012-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care