Healthcare Provider Details

I. General information

NPI: 1073908315
Provider Name (Legal Business Name): EMPACARE HOMECARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2015
Last Update Date: 04/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7231 BOULDER AVE. STE 197
HIGHLAND CA
92346
US

IV. Provider business mailing address

7231 BOULDER AVE. STE 197
HIGHLAND CA
92346
US

V. Phone/Fax

Practice location:
  • Phone: 909-362-0248
  • Fax:
Mailing address:
  • Phone: 909-362-0248
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number12299
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code315D00000X
TaxonomyInpatient Hospice
License Number12299
License Number StateCA

VIII. Authorized Official

Name: JACKYLINE SPRINGER
Title or Position: OWNER/MANAGER
Credential:
Phone: 909-362-0248