Healthcare Provider Details

I. General information

NPI: 1750861746
Provider Name (Legal Business Name): ASCLEPIUS HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2018
Last Update Date: 08/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

267 MONUMENT PKWY
PERRIS CA
92570-5526
US

IV. Provider business mailing address

267 MONUMENT PKWY
PERRIS CA
92570-5526
US

V. Phone/Fax

Practice location:
  • Phone: 626-202-3006
  • Fax:
Mailing address:
  • Phone: 626-202-3006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code335V00000X
TaxonomyPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
License Number
License Number StateNULL
# 6
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateNULL
# 7
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL
# 8
Primary TaxonomyN
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number StateNULL

VIII. Authorized Official

Name: SAMSON NDUNGU
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 626-202-3006