1093798977 NPI number — ETHICAL HOME HEALTH CARE INC

Table of content: (NPI 1093798977)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093798977 NPI number — ETHICAL HOME HEALTH CARE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ETHICAL HOME HEALTH CARE INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1093798977
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/09/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
550 N EUCLID AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
UPLAND
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91786-4734
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
909-946-9000
Provider Business Mailing Address Fax Number:
909-981-0400

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
550 N EUCLID AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
UPLAND
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91786-4734
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-946-9000
Provider Business Practice Location Address Fax Number:
909-981-0400
Provider Enumeration Date:
11/23/2005

Additional Information

Authorized Official

Authorized Official Last Name:
FLORES
Authorized Official First Name:
FERNANDO
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO CFO
Authorized Official Telephone Number:
909-946-9000

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  240000670 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 05-8026 . This is a "MEDICARE PROVIDER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 240000670 . This is a "HHA LICENSE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: HHA08026G , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 406364346 . This is a "OSHPD ID" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 240001549 . This is a "ACLAIMS #" identifier . This identifiers is of the category "OTHER".




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