MEDICARE: MULTI-SKILLED HOME 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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1609863547
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MULTI-SKILLED HOME CARE SERVICES, INC.

Provider Business Mailing Address
First Line	:	19608 CAMINO DE ROSA
Second Line	:
City	:	WALNUT
State	:	CA
Zip	:	91789-2103
Country	:	US
Telephone Number	:	909-595-0200
Fax Number	:	909-595-1211

Provider Business Practice Location Address
First Line	:	19608 CAMINO DE ROSA
Second Line	:
City	:	WALNUT
State	:	CA
Zip	:	91789-2103
Country	:	US
Telephone Number	:	909-595-0200
Fax Number	:	909-595-1211

Authorized Official
Title or Position	:	ADMINISTRATOR DPCS
Name	:	MS. MARIA BRENDA ILAGAN
Credential	:	R.N.
Telephone Number	:	909-595-0200

Provider Enumeration Date	:	10/05/2005
Last Update Date	:	08/22/2020

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