Healthcare Provider Details

I. General information

NPI: 1477558633
Provider Name (Legal Business Name): JAMECO HOME HEALTH AGENCY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2005
Last Update Date: 04/22/2022
Certification Date: 04/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2377 W FOOTHILL BLVD STE 16
UPLAND CA
91786-3584
US

IV. Provider business mailing address

2377 W FOOTHILL BLVD STE 16
UPLAND CA
91786-3584
US

V. Phone/Fax

Practice location:
  • Phone: 909-447-4705
  • Fax: 909-621-6667
Mailing address:
  • Phone: 909-447-4705
  • Fax: 909-621-6667

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number240000830
License Number StateCA

VIII. Authorized Official

Name: AMBREEN KHALID
Title or Position: ADMINISTRATOR
Credential:
Phone: 909-447-4705