Provider Demographics
NPI:1093854176
Name:INLAND HOME HEALTH PROVIDERS, INC.
Entity Type:Organization
Organization Name:INLAND HOME HEALTH PROVIDERS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:RENE
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:YBARDOLAZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-948-8731
Mailing Address - Street 1:9221 ARCHIBALD AVE
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-5207
Mailing Address - Country:US
Mailing Address - Phone:909-948-8731
Mailing Address - Fax:909-948-8736
Practice Address - Street 1:9221 ARCHIBALD AVE
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-5207
Practice Address - Country:US
Practice Address - Phone:909-948-8731
Practice Address - Fax:909-948-8736
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2012-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA240001913251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHHA08239FMedicaid
CA058239Medicare ID - Type Unspecified