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General NPI Number Information
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NPI Number | 1003056292
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Entity Type | Organization
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Legal Business Name | DIRECT PROVIDER OF HEALTHCARE SERVICES, INC.
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Dates
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Enumeration Date | 02/27/2009
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Last Update Date | 09/16/2025
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Provider Practice Location Address
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Address Line | 9320 BASE LINE RD STE B
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91701-5829
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Country | US
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Telephone | 909-483-8311
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Fax | 909-483-8382
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Provider Business Mailing Address
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Address Line | 9320 BASE LINE RD STE B
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91701-5829
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Country | US
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Telephone | 909-483-8311
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Fax | 909-483-8382
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | SUSAN PANGANIBAN
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Credential | RN
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Telephone | 909-483-8311
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State | CA
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