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General NPI Number Information
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NPI Number | 1366625170
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Entity Type | Organization
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Legal Business Name | PRIME CARE HOME HEALTH AGENCY INC
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Dates
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Enumeration Date | 12/14/2007
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Last Update Date | 12/17/2007
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Provider Practice Location Address
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Address Line | 8401 WHITE OAK AVE SUITE 102
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-3869
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Country | US
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Telephone | 909-625-3200
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Fax | 951-272-0289
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Provider Business Mailing Address
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Address Line | PO BOX 1447
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91729-1447
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Country | US
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Telephone | 909-625-3200
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Fax | 951-272-0289
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. EUCHARIA OBASI
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Credential | RN
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Telephone | 909-625-3200
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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 | CA
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