Healthcare Provider Details

I. General information

NPI: 1629207287
Provider Name (Legal Business Name): ABC HOME HEALTH CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/04/2009
Last Update Date: 05/24/2023
Certification Date: 05/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5090 SHOREHAM PL STE 109
SAN DIEGO CA
92122-5934
US

IV. Provider business mailing address

3636 NOBEL DR STE 450
SAN DIEGO CA
92122-1062
US

V. Phone/Fax

Practice location:
  • Phone: 858-455-5000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JEFF MONGONIA
Title or Position: CEO
Credential:
Phone: 858-251-4242