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NPI Code Detail

MEDICARE: COMPANIONSHIP HEALTH PROVIDER, INC

MEDICARE: COMPANIONSHIP HEALTH PROVIDER, INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1251E00000XHome Health AgencyCA

General Provider Information

NPI Number : 1265607030
Entity Type Code : Organization
Provider Name (Legal Business Name) : COMPANIONSHIP HEALTH PROVIDER, INC
Provider Business Mailing Address
First Line : 2608 SPRINGS RD
Second Line : SUITE B
City : VALLEJO
State : CA
Zip : 94591-5713
Country : US
Telephone Number : 707-534-7772
Fax Number :
Provider Business Practice Location Address
First Line : 2608 SPRINGS RD
Second Line : SUITE B
City : VALLEJO
State : CA
Zip : 94591-5713
Country : US
Telephone Number : 707-534-7772
Fax Number :
Authorized Official
Title or Position : CEO
Name : MR. JETT ASINAS MERCADO
Credential : MPA
Telephone Number : 707-853-7042
Provider Enumeration Date : 04/23/2008
Last Update Date : 04/23/2008

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Directions to “COMPANIONSHIP HEALTH PROVIDER, INC ” Practice Location

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