Healthcare Provider Details

I. General information

NPI: 1053297366
Provider Name (Legal Business Name): MEDHOME HEALTHCARE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2025
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1374 N WATERMAN AVE
SAN BERNARDINO CA
92404-5313
US

IV. Provider business mailing address

25448 LAWTON AVE
LOMA LINDA CA
92354-3693
US

V. Phone/Fax

Practice location:
  • Phone: 840-444-7745
  • Fax:
Mailing address:
  • Phone: 951-640-9517
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. KWAME AGYEMAN
Title or Position: MEDICAL DIRECTOR/CEO
Credential: MD
Phone: 951-640-9517