Provider Demographics
NPI:1992126270
Name:EMERALD CORPORATION
Entity type:Organization
Organization Name:EMERALD CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LOIDA
Authorized Official - Middle Name:F
Authorized Official - Last Name:FAJAYAN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:909-627-0408
Mailing Address - Street 1:13791 ROSWELL AVE STE E
Mailing Address - Street 2:
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-5469
Mailing Address - Country:US
Mailing Address - Phone:909-627-0408
Mailing Address - Fax:909-628-4665
Practice Address - Street 1:13791 ROSWELL AVE STE E
Practice Address - Street 2:
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-5469
Practice Address - Country:US
Practice Address - Phone:909-627-0408
Practice Address - Fax:909-628-4665
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-03
Last Update Date:2014-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA240000873251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA058288OtherMEDICARE PROVIDER NUMBER