Healthcare Provider Details

I. General information

NPI: 1699090696
Provider Name (Legal Business Name): PROFESSIONAL IN HOME CARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2010
Last Update Date: 08/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1431 W ROSAMOND BLVD #15D
ROSAMOND CA
93560-7428
US

IV. Provider business mailing address

24307 MAGIC MOUNTAIN PKWY #136
VALENCIA CA
91355-3402
US

V. Phone/Fax

Practice location:
  • Phone: 661-777-9002
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number StateCA

VIII. Authorized Official

Name: JAMIE SCHNABEL
Title or Position: PRESIDENT
Credential:
Phone: 661-777-9002