Healthcare Provider Details

I. General information

NPI: 1619514023
Provider Name (Legal Business Name): FAMILIES CHOICE HOME CARE SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2019
Last Update Date: 12/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

545 N MOUNTAIN AVE STE 209
UPLAND CA
91786-5055
US

IV. Provider business mailing address

545 N MOUNTAIN AVE STE 209
UPLAND CA
91786-5055
US

V. Phone/Fax

Practice location:
  • Phone: 909-303-9377
  • Fax: 909-581-8062
Mailing address:
  • Phone: 909-303-9377
  • Fax: 909-581-8062

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. TIMOTHY ALAN INGRAM
Title or Position: VP OF MARKETING
Credential:
Phone: 909-303-9375