Healthcare Provider Details

I. General information

NPI: 1922101989
Provider Name (Legal Business Name): HOMEAVENUE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8114 TELEGRAPH RD
DOWNEY CA
90240-2140
US

IV. Provider business mailing address

8114 TELEGRAPH RD
DOWNEY CA
90240-2140
US

V. Phone/Fax

Practice location:
  • Phone: 562-927-7660
  • Fax: 562-927-6455
Mailing address:
  • Phone: 562-927-7660
  • Fax: 562-927-6455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number StateCA

VIII. Authorized Official

Name: MRS. NERVILLA AGNES PINEDA
Title or Position: PRESIDENT
Credential: R.N.
Phone: 562-927-7660