Provider Demographics
NPI:1346399219
Name:NEW VISION HOME HEALTH AGENCY, INC.
Entity Type:Organization
Organization Name:NEW VISION HOME HEALTH AGENCY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:JUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-903-7771
Mailing Address - Street 1:12145 MORA DR. UNIT 10
Mailing Address - Street 2:
Mailing Address - City:SANTA FE SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:90670-6052
Mailing Address - Country:US
Mailing Address - Phone:562-903-7771
Mailing Address - Fax:562-903-7779
Practice Address - Street 1:12145 MORA DR. UNIT 10
Practice Address - Street 2:
Practice Address - City:SANTA FE SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:90670-6052
Practice Address - Country:US
Practice Address - Phone:562-903-7771
Practice Address - Fax:562-903-7779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA980001259251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA058047Medicare ID - Type UnspecifiedHOME HEALTH AGENCY