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General NPI Number Information
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NPI Number | 1104223825
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Entity Type | Organization
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Legal Business Name | JADE SPECIALTY HOME HEALTH CARE
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Dates
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Enumeration Date | 11/24/2014
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Last Update Date | 11/24/2014
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Provider Practice Location Address
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Address Line | 828 W JADE WAY
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City | ANAHEIM
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State | CA
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Zip | 92805-2420
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Country | US
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Telephone | 714-797-1153
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Fax |
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Provider Business Mailing Address
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Address Line | 828 W JADE WAY
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City | ANAHEIM
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State | CA
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Zip | 92805-2420
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Country | US
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Telephone | 714-797-1153
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MS. CHANTAL MARIA BANON
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Credential | RN
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Telephone | 714-797-1153
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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 | RN760661
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License Number State | CA
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