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General NPI Number Information
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NPI Number | 1366685299
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Entity Type | Organization
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Legal Business Name | VISITING NURSES SENIOR HOME CARE
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Dates
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Enumeration Date | 04/08/2009
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Last Update Date | 04/08/2009
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Provider Practice Location Address
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Address Line | 13683 CABRILLO CT
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City | FONTANA
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State | CA
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Zip | 92336-3451
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Country | US
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Telephone | 909-240-4120
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Fax |
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Provider Business Mailing Address
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Address Line | 13683 CABRILLO CT
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City | FONTANA
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State | CA
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Zip | 92336-3451
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Country | US
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Telephone | 909-240-4120
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Fax |
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Authorized Official
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Title or Position | INDIVIDUAL OWNER
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Name | MR. MARCUS EDWARD CLARK
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Credential |
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Telephone | 909-240-4120
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WH0200X
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Taxonomy Name | Home Health Registered Nurse
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number |
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License Number State |
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