Provider Demographics
NPI:1598236010
Name:SUPPORTIVE HOME HEALTH, INC.
Entity type:Organization
Organization Name:SUPPORTIVE HOME HEALTH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:LIOR
Authorized Official - Middle Name:
Authorized Official - Last Name:MATIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-982-0847
Mailing Address - Street 1:1202 MONTE VISTA AVE STE 5
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-8209
Mailing Address - Country:US
Mailing Address - Phone:909-982-0847
Mailing Address - Fax:
Practice Address - Street 1:1202 MONTE VISTA AVE STE 5
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-8209
Practice Address - Country:US
Practice Address - Phone:909-982-0847
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-10
Last Update Date:2018-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health