=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477785806
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CAVALRY HOME HEALTH CARE, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/19/2009
-----------------------------------------------------
Last Update Date | 11/12/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 818 W CAMERON AVE
-----------------------------------------------------
City | WEST COVINA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91790-4136
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-473-0395
-----------------------------------------------------
Fax | 626-209-0341
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 818 W CAMERON AVE
-----------------------------------------------------
City | WEST COVINA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91790-4136
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-473-0395
-----------------------------------------------------
Fax | 626-209-0341
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICER
-----------------------------------------------------
Name | ROWENA ELEGADO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 626-473-0395
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------