Provider Demographics
NPI:1053677799
Name:UNITED NURSING PERSONAL CARE, INC
Entity Type:Organization
Organization Name:UNITED NURSING PERSONAL CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DON
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROSA
Authorized Official - Middle Name:A
Authorized Official - Last Name:PORTILLO
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:7602-444-7347
Mailing Address - Street 1:13001 MIRAGE RD
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92392-6311
Mailing Address - Country:US
Mailing Address - Phone:760-244-4737
Mailing Address - Fax:760-244-7033
Practice Address - Street 1:16044 BEAR VALLEY RD STE 5
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-8981
Practice Address - Country:US
Practice Address - Phone:760-244-4737
Practice Address - Fax:760-244-7033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-06
Last Update Date:2012-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home