Healthcare Provider Details

I. General information

NPI: 1043717069
Provider Name (Legal Business Name): AVA MARIE SILAS GLOVER HOME CARE PROVIDER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2018
Last Update Date: 04/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1624 CANYON RD APT 39
SPRING VALLEY CA
91977-6620
US

IV. Provider business mailing address

1624 CANYON RD APT 39
SPRING VALLEY CA
91977-6620
US

V. Phone/Fax

Practice location:
  • Phone: 619-871-5339
  • Fax:
Mailing address:
  • Phone: 619-871-5339
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number7511103237
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: