Provider Demographics
NPI:1366685299
Name:VISITING NURSES SENIOR HOME CARE
Entity Type:Organization
Organization Name:VISITING NURSES SENIOR HOME CARE
Other - Org Name:VISITING NURSES SENIOR HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INDIVIDUAL OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARCUS
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-240-4120
Mailing Address - Street 1:13683 CABRILLO CT
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92336-3451
Mailing Address - Country:US
Mailing Address - Phone:909-240-4120
Mailing Address - Fax:
Practice Address - Street 1:13683 CABRILLO CT
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92336-3451
Practice Address - Country:US
Practice Address - Phone:909-240-4120
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-08
Last Update Date:2009-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes305S00000XManaged Care OrganizationsPoint of Service
No163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Single Specialty