Healthcare Provider Details

I. General information

NPI: 1962635367
Provider Name (Legal Business Name): WATER FOR YOU INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2009
Last Update Date: 06/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9567 ARROW RTE STE L
RANCHO CUCAMONGA CA
91730-4550
US

IV. Provider business mailing address

9567 ARROW RTE STE L
RANCHO CUCAMONGA CA
91730-4550
US

V. Phone/Fax

Practice location:
  • Phone: 909-987-1661
  • Fax: 909-987-1663
Mailing address:
  • Phone: 909-987-1661
  • Fax: 909-987-1663

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number52469
License Number StateCA

VIII. Authorized Official

Name: MRS. LORRIE ELIZABETH STAU
Title or Position: VICE PRESIDENT
Credential:
Phone: 909-987-1661