Healthcare Provider Details

I. General information

NPI: 1356844096
Provider Name (Legal Business Name): ST. FRANCIS HOME HEALTH AGENCY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2018
Last Update Date: 02/07/2020
Certification Date: 02/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10970 ARROW RTE STE 205
RANCHO CUCAMONGA CA
91730-4839
US

IV. Provider business mailing address

10970 ARROW RTE STE 206
RANCHO CUCAMONGA CA
91730-4839
US

V. Phone/Fax

Practice location:
  • Phone: 909-989-7700
  • Fax: 909-457-6353
Mailing address:
  • Phone: 909-989-5383
  • Fax: 909-457-6353

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MARTIN AIYETIWA
Title or Position: PRESIDENT/CEO
Credential:
Phone: 909-989-7700