Healthcare Provider Details

I. General information

NPI: 1275325540
Provider Name (Legal Business Name): IRIE HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2025
Last Update Date: 05/21/2025
Certification Date: 05/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22320 FOOTHILL BLVD STE 130
HAYWARD CA
94541-2719
US

IV. Provider business mailing address

22320 FOOTHILL BLVD STE 130
HAYWARD CA
94541-2719
US

V. Phone/Fax

Practice location:
  • Phone: 501-600-3993
  • Fax: 501-600-3991
Mailing address:
  • Phone: 501-600-3993
  • Fax: 501-600-3991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: ASHLY GRAY
Title or Position: OWNER
Credential:
Phone: 501-600-3993