Healthcare Provider Details

I. General information

NPI: 1952019036
Provider Name (Legal Business Name): PERPETUAL VENTURES. LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2022
Last Update Date: 11/08/2022
Certification Date: 11/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9213 ARCHIBALD AVE
RANCHO CUCAMONGA CA
91730-5207
US

IV. Provider business mailing address

9213 ARCHIBALD AVE
RANCHO CUCAMONGA CA
91730-5207
US

V. Phone/Fax

Practice location:
  • Phone: 909-476-9030
  • Fax: 909-476-9130
Mailing address:
  • Phone: 909-476-9030
  • Fax: 909-476-9130

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 Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name: BRANDI JOHNSON
Title or Position: CEO/OWNER
Credential:
Phone: 909-476-9030