Healthcare Provider Details

I. General information

NPI: 1720589997
Provider Name (Legal Business Name): YOUR HOME CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2018
Last Update Date: 02/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24191 PASEO DA VALENCIA SUITE B
LAGUNA WOODS CA
92637
US

IV. Provider business mailing address

24191 PASEO DA VALENCIA SUITE D
LAGUNA WOODS CA
92637
US

V. Phone/Fax

Practice location:
  • Phone: 949-424-9322
  • Fax:
Mailing address:
  • Phone: 949-424-9322
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number306005324
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number304700158
License Number StateCA

VIII. Authorized Official

Name: MRS. ALISHA FOREMAN
Title or Position: BUSINESS DEVELOPMENT
Credential:
Phone: 949-424-9322