MEDICARE: THE PROMISE HOME HEALTH CARE SERVICES 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
1	251E00000X	Home Health Agency		CA

General Provider Information

NPI Number	:	1346492618
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE PROMISE HOME HEALTH CARE SERVICES INC

Provider Business Mailing Address
First Line	:	15878 W PRESERVE LOOP
Second Line	:
City	:	CHINO
State	:	CA
Zip	:	91708-7653
Country	:	US
Telephone Number	:	562-841-0715
Fax Number	:	909-247-4032

Provider Business Practice Location Address
First Line	:	15878 W PRESERVE LOOP
Second Line	:
City	:	CHINO
State	:	CA
Zip	:	91708-7653
Country	:	US
Telephone Number	:	562-841-0715
Fax Number	:	909-247-4032

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	DR. FERDINAND MORALES LOPEZ
Credential	:	DC
Telephone Number	:	562-841-0715

Provider Enumeration Date	:	10/18/2008
Last Update Date	:	10/18/2008

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