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General NPI Number Information
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NPI Number | 1861077513
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Entity Type | Organization
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Legal Business Name | PRIVATE DUTY HOMECARE GROUP LLP
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Dates
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Enumeration Date | 03/15/2021
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Last Update Date | 03/15/2021
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Provider Practice Location Address
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Address Line | 11101 TORBAY DR
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City | BAKERSFIELD
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State | CA
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Zip | 93311-2921
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Country | US
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Telephone | 305-733-1219
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Fax | 661-412-8288
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Provider Business Mailing Address
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Address Line | PO BOX 21463
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City | BAKERSFIELD
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State | CA
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Zip | 93390-1463
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Country | US
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Telephone | 305-733-1219
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Fax | 661-412-8288
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Authorized Official
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Title or Position | DIRECTOR
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Name | ELIZABETH JOHNSON
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Credential | RN
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Telephone | 305-733-1219
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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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