Provider Demographics
NPI:1275679946
Name:DSP HOME HEALTH, INC.
Entity Type:Organization
Organization Name:DSP HOME HEALTH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARICON
Authorized Official - Middle Name:PADUA
Authorized Official - Last Name:PARDUCHO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-331-2265
Mailing Address - Street 1:1815 E WORKMAN AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91791-1423
Mailing Address - Country:US
Mailing Address - Phone:626-331-2265
Mailing Address - Fax:626-331-7135
Practice Address - Street 1:1815 E WORKMAN AVE
Practice Address - Street 2:SUITE D
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91791-1423
Practice Address - Country:US
Practice Address - Phone:626-331-2265
Practice Address - Fax:626-331-7135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA058053Medicare ID - Type UnspecifiedHOME HEALTH PROVIDER