=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073712097
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | METRO CARE HOME HEALTH SERVICES, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/11/2007
-----------------------------------------------------
Last Update Date | 06/29/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4959 PALO VERDE ST STE 104A
-----------------------------------------------------
City | MONTCLAIR
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91763
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-447-1000
-----------------------------------------------------
Fax | 909-624-5953
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4959 PALO VERDE ST STE 104A
-----------------------------------------------------
City | MONTCLAIR
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91763-2345
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-447-1000
-----------------------------------------------------
Fax | 909-624-5953
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DPCS
-----------------------------------------------------
Name | MS. MARIA CHONA RAFOLS CATUIRA
-----------------------------------------------------
Credential | BSN, RN
-----------------------------------------------------
Telephone | 909-447-1000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 550000203
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------