Provider Demographics
NPI:1316958077
Name:OUR LADY OF LOURDES HOME HEALTH, INC.
Entity type:Organization
Organization Name:OUR LADY OF LOURDES HOME HEALTH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:MASOUD
Authorized Official - Middle Name:
Authorized Official - Last Name:SALEHI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-527-4542
Mailing Address - Street 1:8560 VINEYARD AVE STE 506
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-4350
Mailing Address - Country:US
Mailing Address - Phone:909-527-4543
Mailing Address - Fax:909-527-4544
Practice Address - Street 1:8560 VINEYARD AVE STE 506
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-4350
Practice Address - Country:US
Practice Address - Phone:909-527-4543
Practice Address - Fax:909-527-4544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2024-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2827180251E00000X
CA550000749251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA05-9337Medicaid
CA495500OtherJCAHO
CA495500OtherJCAHO
CA059337Medicare Oscar/Certification