Provider Demographics
NPI:1225663362
Name:PRIORITY HOME CARE
Entity Type:Organization
Organization Name:PRIORITY HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:HAZEL NIKKI
Authorized Official - Middle Name:MANGAOANG
Authorized Official - Last Name:DAVID
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-318-5880
Mailing Address - Street 1:1110 S 5TH AVE UNIT 216
Mailing Address - Street 2:
Mailing Address - City:MONROVIA
Mailing Address - State:CA
Mailing Address - Zip Code:91016-3870
Mailing Address - Country:US
Mailing Address - Phone:818-318-5880
Mailing Address - Fax:
Practice Address - Street 1:1110 S 5TH AVE UNIT 216
Practice Address - Street 2:
Practice Address - City:MONROVIA
Practice Address - State:CA
Practice Address - Zip Code:91016-3870
Practice Address - Country:US
Practice Address - Phone:818-318-5880
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-09
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care