Healthcare Provider Details

I. General information

NPI: 1104759968
Provider Name (Legal Business Name): IRONSIDE HOME HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4140 OCEANSIDE BLVD STE 1591217
OCEANSIDE CA
92056-6005
US

IV. Provider business mailing address

4140 OCEANSIDE BLVD STE 1591217
OCEANSIDE CA
92056-6005
US

V. Phone/Fax

Practice location:
  • Phone: 713-281-6391
  • Fax:
Mailing address:
  • Phone: 713-281-6391
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: TONNA U NWANERI
Title or Position: CLINICAL DIRECTOR
Credential:
Phone: 713-281-6391