Healthcare Provider Details

I. General information

NPI: 1649506171
Provider Name (Legal Business Name): DIRECT CARE MEDICAL RESPITE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2009
Last Update Date: 06/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38713 TIERRA SUBIDA AVE 200-185
PALMDALE CA
93551-4562
US

IV. Provider business mailing address

38713 TIERRA SUBIDA AVE 200-185
PALMDALE CA
93551-4562
US

V. Phone/Fax

Practice location:
  • Phone: 661-860-2167
  • Fax: 611-233-9817
Mailing address:
  • Phone: 661-860-2167
  • Fax: 661-233-9817

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number207368
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number207368
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number207368
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number207368
License Number StateCA

VIII. Authorized Official

Name: MR. CEDRIC HARBERT
Title or Position: DIRECTOR
Credential: LVN
Phone: 661-860-2167