Coordinated Care Center, Inc

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

COORDINATED CARE CENTER, INC

Practice address

6812 Oak Ave
San Gabriel, CA 91775-2030

Phone

(626) 446-5263

Fax

(626) 446-8109

NPI assigned

Sep 30, 2005

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Michael W. Elbert

Title

Administrator

Phone

(626) 446-5263

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• San Marino Manor Other name

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1128038400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1922095215",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6812 OAK AVE",
            "city": "SAN GABRIEL",
            "state": "CA",
            "postal_code": "917752030",
            "telephone_number": "626-446-5263",
            "fax_number": "626-446-8109"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6812 OAK AVE",
            "city": "SAN GABRIEL",
            "state": "CA",
            "postal_code": "917752030",
            "telephone_number": "626-446-5263",
            "fax_number": "626-446-8109"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COORDINATED CARE CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-30",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "ELBERT",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "W.",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "626-446-5263",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZZT18606F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "San Marino Manor",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Skilled Nursing Facility in San Gabriel, CA
• Providers in San Gabriel, CA by specialty
• Skilled Nursing Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.