Healthcare Provider Details

I. General information

NPI: 1538411624
Provider Name (Legal Business Name): HOME CHOICE RENAL CARE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2012
Last Update Date: 10/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1738 E MOBECK ST
WEST COVINA CA
91791-2630
US

IV. Provider business mailing address

1738 EAST MOBECK STREET
WEST COVINA CA
91791-2630
US

V. Phone/Fax

Practice location:
  • Phone: 626-732-6985
  • Fax: 877-206-1926
Mailing address:
  • Phone: 626-732-6985
  • Fax: 877-206-1926

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD1100X
TaxonomyPeritoneal Dialysis Registered Nurse
License Number596236
License Number StateCA

VIII. Authorized Official

Name: GEORGINA TORRES
Title or Position: PRESIDENT & CEO
Credential: REGISTERED NURSE
Phone: 626-732-6985