=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407916786
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | C & F HOME HEALTH AGENCY INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/09/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4959 PALO VERDE ST 103A-5
-----------------------------------------------------
City | MONTCLAIR
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91763-2331
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-626-9575
-----------------------------------------------------
Fax | 909-626-9575
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4959 PALO VERDE ST 103A-5
-----------------------------------------------------
City | MONTCLAIR
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91763-2331
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-626-9575
-----------------------------------------------------
Fax | 909-626-9575
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESINDENT ADMINISTRATOR DPCS
-----------------------------------------------------
Name | MRS. GRICELDA CECILIA CAMPOS
-----------------------------------------------------
Credential | REGISTERED NURSE
-----------------------------------------------------
Telephone | 909-952-0990
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | C2889699
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------