Provider Demographics
NPI:1194240002
Name:CRESTLINE HOME HEALTH, INC.
Entity type:Organization
Organization Name:CRESTLINE HOME HEALTH, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RUBEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SUKIASYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-453-3287
Mailing Address - Street 1:600 N MOUNTAIN AVE STE D106
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-4359
Mailing Address - Country:US
Mailing Address - Phone:909-453-3287
Mailing Address - Fax:909-453-3213
Practice Address - Street 1:600 N MOUNTAIN AVE STE D106
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-4359
Practice Address - Country:US
Practice Address - Phone:909-453-3287
Practice Address - Fax:909-453-3213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-11
Last Update Date:2019-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health