Healthcare Provider Details

I. General information

NPI: 1952942153
Provider Name (Legal Business Name): CLINICIANS HOME HEALTH PROVIDERS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

237 W BONITA AVE STE B
SAN DIMAS CA
91773-3048
US

IV. Provider business mailing address

237 W BONITA AVE STE B
SAN DIMAS CA
91773-3048
US

V. Phone/Fax

Practice location:
  • Phone: 909-542-9090
  • Fax: 909-542-9152
Mailing address:
  • Phone: 909-542-9090
  • Fax: 909-542-9152

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL L FOLKES
Title or Position: ADMINISTRATOR
Credential:
Phone: 909-542-9090