Healthcare Provider Details

I. General information

NPI: 1336635663
Provider Name (Legal Business Name): JADE ELIZABETH CUCCIA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2018
Last Update Date: 07/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

226 BONTA ST
BLAIRSDEN CA
96103-9000
US

IV. Provider business mailing address

226 BONTA ST # 121
BLAIRSDEN CA
96103-9000
US

V. Phone/Fax

Practice location:
  • Phone: 530-737-9622
  • Fax:
Mailing address:
  • Phone: 530-737-9622
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number00997122
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: