Healthcare Provider Details

I. General information

NPI: 1154790731
Provider Name (Legal Business Name): DESIRE HOME CARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2015
Last Update Date: 01/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10759 MAGNOLIA AVE STE J
RIVERSIDE CA
92505-3082
US

IV. Provider business mailing address

3742 TIBBETTS ST STE 203
RIVERSIDE CA
92506-2641
US

V. Phone/Fax

Practice location:
  • Phone: 951-376-8018
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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

VIII. Authorized Official

Name: YENEOCHIA IKHELOWA
Title or Position: ADMINISTRATOR
Credential:
Phone: 951-376-8018