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Organization

PRIMARY RELIANCE INC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MS. CELESTINE GREEN (OWNER)
(626) 966-1373
Entity
Organization

Contact information

Practice address
1342 PASEO ENCINAS, SAN DIMAS, CA 91773-4217
(909) 599-4396
Mailing address
226 N STEPHORA AVE, COVINA, CA 91724-3152
(626) 966-1373
(626) 915-1155

Taxonomy

Speciality
Code
Description
License number
State
3104A0625X
Assisted Living Facility (Mental Illness)
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
LTC60598F
ENCINAS PROVIDER NO.
CA
Enumeration date
03/19/2007
Last updated
08/22/2020
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