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General NPI Number Information
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NPI Number | 1891079414
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Entity Type | Organization
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Legal Business Name | SUSAN'S CARE AGENCY
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Dates
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Enumeration Date | 09/30/2011
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Last Update Date | 09/30/2011
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Provider Practice Location Address
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Address Line | 18100 HERBOLD ST.
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City | NORTHRIDGE
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State | CA
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Zip | 91325
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Country | US
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Telephone | 818-481-3945
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Fax |
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Provider Business Mailing Address
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Address Line | 18100 HERBOLD ST.
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City | NORTHRIDGE
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State | CA
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Zip | 91325
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Country | US
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Telephone | 818-481-3945
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. SUSAN NUNEZ REPOLLO
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Credential | CNA/PHLEBOTOMIST
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Telephone | 818-481-4935
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | 3396260
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License Number State | CA
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