MEDICARE: PM HOME CARE SERVICES LLC

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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1598406571
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PM HOME CARE SERVICES LLC

Provider Business Mailing Address
First Line	:	13641 CENTRAL AVE STE A
Second Line	:
City	:	CHINO
State	:	CA
Zip	:	91710-5133
Country	:	US
Telephone Number	:	909-256-0240
Fax Number	:	909-867-5007

Provider Business Practice Location Address
First Line	:	13641 CENTRAL AVE STE A
Second Line	:
City	:	CHINO
State	:	CA
Zip	:	91710-5133
Country	:	US
Telephone Number	:	909-256-0240
Fax Number	:	909-867-5007

Authorized Official
Title or Position	:	DIRECTOR OF OPERATIONS
Name	:	MR. PATRICK MOSKUS
Credential	:
Telephone Number	:	909-256-0240

Provider Enumeration Date	:	04/05/2022
Last Update Date	:	04/08/2022

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