Provider Demographics
NPI:1164204228
Name:DIGNITY AND WISDOM HOME CARE LLC
Entity Type:Organization
Organization Name:DIGNITY AND WISDOM HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SABA
Authorized Official - Middle Name:Y
Authorized Official - Last Name:TESFAY
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:714-261-7435
Mailing Address - Street 1:2255 EL RANCHO VIS
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92833-1725
Mailing Address - Country:US
Mailing Address - Phone:714-261-7435
Mailing Address - Fax:714-451-4488
Practice Address - Street 1:17331 VINEWOOD AVE
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-2550
Practice Address - Country:US
Practice Address - Phone:714-261-7435
Practice Address - Fax:714-451-4488
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DIGNITY AND WISDOME HOME CARE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-10-13
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility