Provider Demographics
NPI:1720893084
Name:ALYCARE HOME HEALTH, INC.
Entity type:Organization
Organization Name:ALYCARE HOME HEALTH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NERISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:BANZON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-596-0052
Mailing Address - Street 1:14443 PARK AVE STE A3
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92392-2388
Mailing Address - Country:US
Mailing Address - Phone:760-596-0052
Mailing Address - Fax:
Practice Address - Street 1:14443 PARK AVE STE A3
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92392-2388
Practice Address - Country:US
Practice Address - Phone:760-596-0052
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-12
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health