Healthcare Provider Details

I. General information

NPI: 1083084123
Provider Name (Legal Business Name): ABOVE & BEYOND HOMECARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2015
Last Update Date: 10/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35552 CORNELL DR
YUCAIPA CA
92399-3932
US

IV. Provider business mailing address

35552 CORNELL DR
YUCAIPA CA
92399-3932
US

V. Phone/Fax

Practice location:
  • Phone: 909-206-3104
  • Fax:
Mailing address:
  • Phone: 909-206-3104
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number12796
License Number StateCA

VIII. Authorized Official

Name: CARRIE ANN CORNELL
Title or Position: OWNER/MANAGER/HHA
Credential:
Phone: 909-206-3104