Healthcare Provider Details

I. General information

NPI: 1144816513
Provider Name (Legal Business Name): VALLEYCHOICE HOME HEALTH EXTENDERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2020
Last Update Date: 12/18/2020
Certification Date: 12/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17625 CENTRAL AVE STE C
CARSON CA
90746-1661
US

IV. Provider business mailing address

17625 CENTRAL AVE STE C
CARSON CA
90746-1661
US

V. Phone/Fax

Practice location:
  • Phone: 310-228-8682
  • Fax:
Mailing address:
  • Phone: 310-228-8682
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. IKE OGBODO
Title or Position: MANAGER
Credential: NURSE PRACTITIONER
Phone: 310-228-8682