Healthcare Provider Details

I. General information

NPI: 1982663407
Provider Name (Legal Business Name): HIGHMARK HOME HEALTH, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2006
Last Update Date: 07/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2707 E VALLEY BLVD STE 209
WEST COVINA CA
91792-3197
US

IV. Provider business mailing address

2707 E VALLEY BLVD STE 209
WEST COVINA CA
91792-3197
US

V. Phone/Fax

Practice location:
  • Phone: 626-810-1957
  • Fax: 626-810-4805
Mailing address:
  • Phone: 626-810-1957
  • Fax: 626-810-4805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number058261
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License NumberHP3158
License Number StateCA

VIII. Authorized Official

Name: MRS. MARIA CRISTINA CHUA SY
Title or Position: CEO/PRESIDENT
Credential:
Phone: 626-810-1957