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Organization
PRIMARY RELIANCE INC.
Active
Organization
PRIMARY RELIANCE INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. CELESTINE GREEN (PRESIDENT)
(626) 339-3913
Entity
Organization
Contact information
Practice address
16212 BENWICK ST, LA PUENTE, CA 91744-1301
(626) 917-2412
Mailing address
226 N STEPHORA AVE, COVINA, CA 91724-3152
(626) 339-3913
Taxonomy
Speciality
Code
Description
License number
State
3104A0625X
Assisted Living Facility (Mental Illness)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LTC60678F
ICF DDH - BENWICK
CA
Enumeration date
02/21/2007
Last updated
08/22/2020
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