Provider Demographics
NPI:1386964740
Name:POMONA VALLEY HOME CARE
Entity type:Organization
Organization Name:POMONA VALLEY HOME CARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:M.
Authorized Official - Middle Name:ILYAS
Authorized Official - Last Name:ZAHOOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-394-9400
Mailing Address - Street 1:1109 VIA VERDE
Mailing Address - Street 2:
Mailing Address - City:SAN DIMAS
Mailing Address - State:CA
Mailing Address - Zip Code:91773-4400
Mailing Address - Country:US
Mailing Address - Phone:909-394-9400
Mailing Address - Fax:
Practice Address - Street 1:1109 VIA VERDE
Practice Address - Street 2:
Practice Address - City:SAN DIMAS
Practice Address - State:CA
Practice Address - Zip Code:91773-4400
Practice Address - Country:US
Practice Address - Phone:909-394-9400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-08
Last Update Date:2020-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1479440Medicaid
CA059486Medicare PIN