Healthcare Provider Details

I. General information

NPI: 1811139074
Provider Name (Legal Business Name): CATHERINE L VINCENT M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2009
Last Update Date: 04/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1259 BROOKSIDE AVE
REDLANDS CA
92373-4402
US

IV. Provider business mailing address

PO BOX 2271
REDLANDS CA
92373-0761
US

V. Phone/Fax

Practice location:
  • Phone: 909-792-5888
  • Fax:
Mailing address:
  • Phone: 909-792-5888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number23-762084
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number23-762084
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number23-762084
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code372500000X
TaxonomyChore Provider
License Number23-762084
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number23-762084
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number23-762084
License Number StateCA
# 7
Primary TaxonomyN
Taxonomy Code171W00000X
TaxonomyContractor
License Number23-762084
License Number StateCA
# 8
Primary TaxonomyN
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number23-762084
License Number StateCA
# 9
Primary TaxonomyN
Taxonomy Code171WV0202X
TaxonomyVehicle Modifications Contractor
License Number23-762084
License Number StateCA
# 10
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License Number23-762084
License Number StateCA
# 11
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number23-762084
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: