=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417742784
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ANAWIM HEALTHCARE SERVICES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/09/2025
-----------------------------------------------------
Last Update Date | 04/09/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 15447 ANACAPA RD STE 200
-----------------------------------------------------
City | VICTORVILLE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92392-2490
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-912-4221
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15447 ANACAPA RD STE 200
-----------------------------------------------------
City | VICTORVILLE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92392-2490
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-912-4221
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | NOLIEVER RODRIGUEZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 760-912-4221
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------