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General NPI Number Information
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NPI Number | 1053297366
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Entity Type | Organization
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Legal Business Name | MEDHOME HEALTHCARE INC.
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Dates
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Enumeration Date | 08/12/2025
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Last Update Date | 01/25/2026
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Provider Practice Location Address
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Address Line | 1374 N WATERMAN AVE
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City | SAN BERNARDINO
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State | CA
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Zip | 92404-5313
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Country | US
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Telephone | 840-444-7745
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Fax |
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Provider Business Mailing Address
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Address Line | 25448 LAWTON AVE
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City | LOMA LINDA
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State | CA
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Zip | 92354-3693
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Country | US
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Telephone | 951-640-9517
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR/CEO
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Name | DR. KWAME AGYEMAN
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Credential | MD
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Telephone | 951-640-9517
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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