Healthcare Provider Details

I. General information

NPI: 1770347650
Provider Name (Legal Business Name): HEALING PALMS HEALTHCARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2024
Last Update Date: 02/12/2024
Certification Date: 02/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11175 AZUSA CT STE 110
RANCHO CUCAMONGA CA
91730-4933
US

IV. Provider business mailing address

11175 AZUSA CT STE 110
RANCHO CUCAMONGA CA
91730-4933
US

V. Phone/Fax

Practice location:
  • Phone: 310-528-5848
  • Fax:
Mailing address:
  • Phone: 310-528-5848
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: JUDE E OKWOR
Title or Position: ADMINISTRATOR
Credential:
Phone: 310-528-5848