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General NPI Number Information
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NPI Number | 1629219902
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Entity Type | Organization
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Legal Business Name | PROFESSIONAL NURSES HOMEHEALTH LLC
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Dates
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Enumeration Date | 03/16/2009
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Last Update Date | 03/16/2009
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Provider Practice Location Address
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Address Line | 2037 N D ST STE 109
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City | SAN BERNARDINO
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State | CA
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Zip | 92405-3936
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Country | US
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Telephone | 909-518-8469
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Fax |
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Provider Business Mailing Address
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Address Line | 1740 N PRIMROSE AVE
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City | RIALTO
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State | CA
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Zip | 92376-2933
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OPERATING MANAGER
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Name | MISS M ELVA DELL HUFF
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Credential | LVN
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Telephone | 909-518-8469
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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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