Provider Demographics
NPI:1023019353
Name:INTENSIVE HOME HEALTH CARE INC.
Entity Type:Organization
Organization Name:INTENSIVE HOME HEALTH CARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASST. ADMIN. / CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:CHERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:THACKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-595-8383
Mailing Address - Street 1:21671 GATEWAY CENTER DR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:DIAMOND BAR
Mailing Address - State:CA
Mailing Address - Zip Code:91765
Mailing Address - Country:US
Mailing Address - Phone:909-595-8383
Mailing Address - Fax:909-595-4450
Practice Address - Street 1:1163 FAIRWAY DR
Practice Address - Street 2:SUITE 105
Practice Address - City:CITY OF INDUSTRY
Practice Address - State:CA
Practice Address - Zip Code:91789-2846
Practice Address - Country:US
Practice Address - Phone:909-595-8383
Practice Address - Fax:909-595-4450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-09
Last Update Date:2017-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA980001468251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHHA08213FMedicaid
CAHHA08213FMedicaid