MEDICARE: HIGHMARK HOME HEALTH, 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	385HR2060X	Child Intellectual and/or Developmental Disabilities Respite Care	HP3158	CA
2	251E00000X	Home Health Agency	058261	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	:	1982663407
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HIGHMARK HOME HEALTH, INC

Provider Business Mailing Address
First Line	:	2707 E VALLEY BLVD STE 209
Second Line	:
City	:	WEST COVINA
State	:	CA
Zip	:	91792-3197
Country	:	US
Telephone Number	:	626-810-1957
Fax Number	:	626-810-4805

Provider Business Practice Location Address
First Line	:	2707 E VALLEY BLVD STE 209
Second Line	:
City	:	WEST COVINA
State	:	CA
Zip	:	91792-3197
Country	:	US
Telephone Number	:	626-810-1957
Fax Number	:	626-810-4805

Authorized Official
Title or Position	:	CEO/PRESIDENT
Name	:	MRS. MARIA CRISTINA CHUA SY
Credential	:
Telephone Number	:	626-810-1957

Provider Enumeration Date	:	03/22/2006
Last Update Date	:	07/09/2010

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