Provider Demographics
NPI:1699061127
Name:INDEPENDENCE HOME CARE, INC.
Entity type:Organization
Organization Name:INDEPENDENCE HOME CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND C.E.O.
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:NOWELL
Authorized Official - Suffix:
Authorized Official - Credentials:CNA, CMA
Authorized Official - Phone:949-338-2587
Mailing Address - Street 1:4500 CAMPUS DR
Mailing Address - Street 2:SUITE #318
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-1814
Mailing Address - Country:US
Mailing Address - Phone:949-357-6121
Mailing Address - Fax:949-209-1981
Practice Address - Street 1:4500 CAMPUS DR
Practice Address - Street 2:SUITE #318
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-1814
Practice Address - Country:US
Practice Address - Phone:949-357-6121
Practice Address - Fax:949-209-1981
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-23
Last Update Date:2011-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CABT30035858251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health