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General NPI Number Information
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NPI Number | 1518439827
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Entity Type | Organization
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Legal Business Name | ABSALOM HOME HEALTH AGENCY LLC
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Dates
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Enumeration Date | 12/27/2018
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Last Update Date | 03/23/2020
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Provider Practice Location Address
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Address Line | 1283 E MAIN ST STE 201
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City | EL CAJON
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State | CA
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Zip | 92021-7252
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Country | US
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Telephone | 858-252-3678
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Fax |
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Provider Business Mailing Address
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Address Line | 3602 TAVARA CIR
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City | SAN DIEGO
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State | CA
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Zip | 92117-3752
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Country | US
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Telephone | 617-754-3441
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. AUSTIN MOWOE
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Credential | PA
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Telephone | 619-754-3441
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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