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General NPI Number Information
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NPI Number | 1669778882
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Entity Type | Organization
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Legal Business Name | HOLY HILL HOME CARE
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Dates
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Enumeration Date | 02/04/2011
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Last Update Date | 01/11/2012
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Provider Practice Location Address
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Address Line | 33922 COLORADO ST
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City | YUCAIPA
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State | CA
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Zip | 92399-2330
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Country | US
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Telephone | 909-446-0296
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Fax | 909-446-0296
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Provider Business Mailing Address
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Address Line | 33922 COLORADO ST
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City | YUCAIPA
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State | CA
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Zip | 92399-2330
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Country | US
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Telephone | 909-446-0296
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Fax | 909-447-0296
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Authorized Official
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Title or Position | OWNER
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Name | MRS. MARIA PURACI
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Credential | LVN
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Telephone | 909-446-0296
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 366402904
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License Number State | CA
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