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General NPI Number Information
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NPI Number | 1235459843
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Entity Type | Organization
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Legal Business Name | MODERN HOME HEALTH CARE, INC.
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Dates
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Enumeration Date | 06/04/2010
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Last Update Date | 09/05/2013
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Provider Practice Location Address
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Address Line | 3130 BONITA RD SUITE 103
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City | CHULA VISTA
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State | CA
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Zip | 91910-3263
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Country | US
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Telephone | 619-476-6619
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Fax | 619-585-1798
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Provider Business Mailing Address
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Address Line | 3130 BONITA RD SUITE 103
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City | CHULA VISTA
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State | CA
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Zip | 91910-3263
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Country | US
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Telephone | 619-476-6619
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Fax | 619-585-1798
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Authorized Official
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Title or Position | DOPCS / ADMINISTRATOR
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Name | MRS. TITA T MANGLICMOT
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Credential | RN
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Telephone | 619-476-6619
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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 |
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