Healthcare Provider Details

I. General information

NPI: 1639140346
Provider Name (Legal Business Name): PROFESSIONAL NURSES GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2006
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4845 CHEYENNE WAY
CHINO CA
91710-5510
US

IV. Provider business mailing address

4845 CHEYENNE WAY
CHINO CA
91710-5510
US

V. Phone/Fax

Practice location:
  • Phone: 626-289-8999
  • Fax: 626-382-0888
Mailing address:
  • Phone: 626-289-8999
  • Fax: 626-382-0888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number980001335
License Number StateCA

VIII. Authorized Official

Name: MR. HERMAN DJUHANA
Title or Position: CEO/PRESIDENT
Credential:
Phone: 626-289-8999