Healthcare Provider Details

I. General information

NPI: 1942803085
Provider Name (Legal Business Name): HOME CARE OF LOMA LINDA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2020
Last Update Date: 11/20/2020
Certification Date: 11/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25553 HURON ST
LOMA LINDA CA
92354-3722
US

IV. Provider business mailing address

25553 HURON ST
LOMA LINDA CA
92354-3722
US

V. Phone/Fax

Practice location:
  • Phone: 909-796-8265
  • Fax: 909-796-8265
Mailing address:
  • Phone: 909-796-8265
  • Fax: 909-796-8265

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code177F00000X
TaxonomyLodging Provider
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number StateNULL

VIII. Authorized Official

Name: ANTHONY TORRES
Title or Position: ADMINISTRATOR/MANAGING MEMBER
Credential:
Phone: 909-319-8354