Provider Demographics
NPI:1487789012
Name:PATIENT CARE HOME HEALTH SERVICES, INC
Entity type:Organization
Organization Name:PATIENT CARE HOME HEALTH SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MORENO
Authorized Official - Middle Name:PROBADORA
Authorized Official - Last Name:DE LA ROSA
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:909-590-4838
Mailing Address - Street 1:12474 CENTRAL AVE STE B
Mailing Address - Street 2:
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-2673
Mailing Address - Country:US
Mailing Address - Phone:909-590-4838
Mailing Address - Fax:909-590-4826
Practice Address - Street 1:12474 CENTRAL AVE STE B
Practice Address - Street 2:
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-2673
Practice Address - Country:US
Practice Address - Phone:909-590-4838
Practice Address - Fax:909-590-4826
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2009-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHHA08312FMedicaid
CA05-8312Medicare ID - Type Unspecified