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General NPI Number Information
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NPI Number | 1497194773
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Entity Type | Organization
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Legal Business Name | EMPHACARE HOME CARE AGENCY LLC
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Dates
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Enumeration Date | 06/19/2013
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Last Update Date | 06/19/2013
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Provider Practice Location Address
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Address Line | 7231 BOULDER AVE STE. # 197
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City | HIGHLAND
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State | CA
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Zip | 92346-3313
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Country | US
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Telephone | 909-362-0248
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Fax | 909-363-8679
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Provider Business Mailing Address
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Address Line | 7231 BOULDER AVE STE. # 197
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City | HIGHLAND
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State | CA
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Zip | 92346-3313
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Country | US
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Telephone | 909-362-0248
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Fax | 909-363-8679
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | MS. JACKYLINE M MITCHELL
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Credential | C.N.A.
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Telephone | 909-362-0248
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number | 11549
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | 11549
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License Number State | CA
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