Healthcare Provider Details

I. General information

NPI: 1992924096
Provider Name (Legal Business Name): PREFERRED HOME HEALTH PROVIDER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2007
Last Update Date: 06/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8560 VINEYARD AVE
RANCHO CUCAMONGA CA
91730-4349
US

IV. Provider business mailing address

8560 VINEYARD AVE SUITE 505
RANCHO CUCAMONGA CA
91730-4349
US

V. Phone/Fax

Practice location:
  • Phone: 909-980-9518
  • Fax: 909-980-9521
Mailing address:
  • Phone: 909-980-9518
  • Fax: 909-980-9521

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number550000194
License Number StateCA

VIII. Authorized Official

Name: MS. CARIE LIMOS DUPRE
Title or Position: ADMINISTRATOR
Credential:
Phone: 909-980-9518