Healthcare Provider Details

I. General information

NPI: 1033161260
Provider Name (Legal Business Name): IN HOME HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 03/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 IOWA AVE SUITE 230
RIVERSIDE CA
92507-2420
US

IV. Provider business mailing address

333 N SUMMIT ST ATTN: DEAN SHIPMAN
TOLEDO OH
43604-1531
US

V. Phone/Fax

Practice location:
  • Phone: 951-369-8604
  • Fax: 951-715-4594
Mailing address:
  • Phone: 419-254-7841
  • Fax: 419-252-6448

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number080000731
License Number StateCA

VIII. Authorized Official

Name: MR. BARRY A LAZARUS
Title or Position: VICE PRESIDENT - REIMBURSEMENTS
Credential:
Phone: 419-252-5541