Provider Demographics
NPI:1033858907
Name:MADERA HOME HEALTH AGENCY, INC.
Entity Type:Organization
Organization Name:MADERA HOME HEALTH AGENCY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/CFO/SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:SIR
Authorized Official - Middle Name:
Authorized Official - Last Name:FARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:747-264-4140
Mailing Address - Street 1:2323 W LINCOLN AVE STE 203C
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-5100
Mailing Address - Country:US
Mailing Address - Phone:747-264-4140
Mailing Address - Fax:
Practice Address - Street 1:2323 W LINCOLN AVE STE 203C
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-5100
Practice Address - Country:US
Practice Address - Phone:747-264-4140
Practice Address - Fax:747-264-4322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-31
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health