Healthcare Provider Details

I. General information

NPI: 1215503768
Provider Name (Legal Business Name): CARRY ME HOME INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2021
Last Update Date: 10/01/2021
Certification Date: 10/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5787 LITTLE SHAY DR
FONTANA CA
92336-4593
US

IV. Provider business mailing address

5787 LITTLE SHAY DR
FONTANA CA
92336-4593
US

V. Phone/Fax

Practice location:
  • Phone: 909-904-7003
  • Fax: 909-945-9799
Mailing address:
  • Phone: 909-904-7003
  • Fax: 909-945-9799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code311Z00000X
TaxonomyCustodial Care Facility
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code177F00000X
TaxonomyLodging Provider
License Number
License Number StateNULL
# 6
Primary TaxonomyN
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number StateNULL
# 7
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name: MARIA CATHERINE CHUA
Title or Position: ADMINISTRATOR
Credential:
Phone: 909-904-7003