Provider Demographics
NPI:1992924096
Name:PREFERRED HOME HEALTH PROVIDER INC
Entity type:Organization
Organization Name:PREFERRED HOME HEALTH PROVIDER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CARIE
Authorized Official - Middle Name:LIMOS
Authorized Official - Last Name:DUPRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-980-9518
Mailing Address - Street 1:8560 VINEYARD AVE
Mailing Address - Street 2:SUITE 505
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-4349
Mailing Address - Country:US
Mailing Address - Phone:909-980-9518
Mailing Address - Fax:909-980-9521
Practice Address - Street 1:8560 VINEYARD AVE
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-4349
Practice Address - Country:US
Practice Address - Phone:909-980-9518
Practice Address - Fax:909-980-9521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA550000194314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA550000194OtherDHS LICENSE NUMBER