Provider Demographics
NPI:1154867828
Name:CHILDREN'S HOME HEALTHCARE
Entity Type:Organization
Organization Name:CHILDREN'S HOME HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF NURSING
Authorized Official - Prefix:
Authorized Official - First Name:CLARENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:DEMETRIO
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:858-882-7834
Mailing Address - Street 1:8920 ACTIVITY RD
Mailing Address - Street 2:SUITE I
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92126-4458
Mailing Address - Country:US
Mailing Address - Phone:858-882-7834
Mailing Address - Fax:858-345-3734
Practice Address - Street 1:8920 ACTIVITY RD
Practice Address - Street 2:SUITE I
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92126-4458
Practice Address - Country:US
Practice Address - Phone:858-882-7834
Practice Address - Fax:858-345-3734
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-18
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health