Healthcare Provider Details

I. General information

NPI: 1235830449
Provider Name (Legal Business Name): MAKING LIFE WONDERFUL (MLW), INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2023
Last Update Date: 03/14/2023
Certification Date: 03/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5558 CAPELLA PL
RANCHO CUCAMONGA CA
91739-2279
US

IV. Provider business mailing address

5558 CAPELLA PL
RANCHO CUCAMONGA CA
91739-2279
US

V. Phone/Fax

Practice location:
  • Phone: 909-500-1299
  • Fax: 951-319-4206
Mailing address:
  • Phone: 909-500-1299
  • Fax: 951-319-4206

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3140N1450X
TaxonomyPediatric Skilled Nursing Facility
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: MRS. MICHELLE LYNN WHITE
Title or Position: CEO/ADMINISTRATOR
Credential: REGISTERED NURSE
Phone: 909-201-6169