Healthcare Provider Details

I. General information

NPI: 1003704719
Provider Name (Legal Business Name): A1 PEACE HOMECARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2025
Last Update Date: 06/24/2025
Certification Date: 06/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16702 WEGMAN DR
LA PUENTE CA
91744-4855
US

IV. Provider business mailing address

16702 WEGMAN DR
LA PUENTE CA
91744-4855
US

V. Phone/Fax

Practice location:
  • Phone: 310-408-1933
  • Fax:
Mailing address:
  • Phone: 310-408-1933
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MI JUNG BAK
Title or Position: DIRECTOR OF NURSE
Credential:
Phone: 213-863-0546