1992924096 NPI number — PREFERRED HOME HEALTH PROVIDER INC

Table of content: (NPI 1992924096)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992924096 NPI number — PREFERRED HOME HEALTH PROVIDER INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PREFERRED HOME HEALTH PROVIDER 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:
1992924096
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/13/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8560 VINEYARD AVE
Provider Second Line Business Mailing Address:
SUITE 505
Provider Business Mailing Address City Name:
RANCHO CUCAMONGA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91730-4349
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
909-980-9518
Provider Business Mailing Address Fax Number:
909-980-9521

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8560 VINEYARD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RANCHO CUCAMONGA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91730-4349
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-980-9518
Provider Business Practice Location Address Fax Number:
909-980-9521
Provider Enumeration Date:
04/25/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DUPRE
Authorized Official First Name:
CARIE
Authorized Official Middle Name:
LIMOS
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
909-980-9518

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  550000194 , 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: 550000194 . This is a "DHS LICENSE NUMBER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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