Healthcare Provider Details

I. General information

NPI: 1487613147
Provider Name (Legal Business Name): FMM HOME CARE CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2006
Last Update Date: 06/16/2025
Certification Date: 06/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4649 BROCKTON AVE
RIVERSIDE CA
92506-0131
US

IV. Provider business mailing address

4649 BROCKTON AVE
RIVERSIDE CA
92506-0131
US

V. Phone/Fax

Practice location:
  • Phone: 951-924-7751
  • Fax: 951-924-9042
Mailing address:
  • Phone: 951-924-7751
  • Fax: 951-924-9042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number250000608
License Number StateCA

VIII. Authorized Official

Name: MS. DOLORES DIZON
Title or Position: BILLING MANAGER
Credential:
Phone: 951-924-7751