Healthcare Provider Details

I. General information

NPI: 1063950780
Provider Name (Legal Business Name): HEART TO HEARTS CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2017
Last Update Date: 02/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15437 ANACAPA RD SUIT 31
VICTORVILLE CA
92392-2458
US

IV. Provider business mailing address

10881 POPLAR ST
LOMA LINDA CA
92354-2226
US

V. Phone/Fax

Practice location:
  • Phone: 951-675-9058
  • Fax:
Mailing address:
  • Phone: 951-675-9058
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number201210710137
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number201210710137
License Number StateCA

VIII. Authorized Official

Name: MR. EMMANUEL KHUMALO
Title or Position: DIRECTOR
Credential:
Phone: 951-675-9058