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General NPI Number Information
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NPI Number | 1326773185
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Entity Type | Organization
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Legal Business Name | FAMILY HOME LLC
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Dates
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Enumeration Date | 07/17/2022
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Last Update Date | 07/17/2022
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Provider Practice Location Address
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Address Line | 1629 CALLE CIERVOS
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City | SAN DIMAS
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State | CA
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Zip | 91773-4119
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Country | US
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Telephone | 626-354-0265
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Fax |
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Provider Business Mailing Address
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Address Line | 1629 CALLE CIERVOS
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City | SAN DIMAS
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State | CA
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Zip | 91773-4119
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Country | US
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Telephone | 626-354-0265
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JOEL VILLALVA
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Credential |
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Telephone | 626-354-0265
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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