Provider Demographics
NPI:1376977462
Name:DE PORRES HEALTHCARE CORPORATION
Entity Type:Organization
Organization Name:DE PORRES HEALTHCARE CORPORATION
Other - Org Name:DE PORRES HOME HEALTHCARE SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ELVIRA
Authorized Official - Middle Name:D
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:209-981-6568
Mailing Address - Street 1:1130 N EL DORADO ST
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95202-1332
Mailing Address - Country:US
Mailing Address - Phone:209-981-6568
Mailing Address - Fax:209-937-6408
Practice Address - Street 1:1130 N EL DORADO ST
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95202-1332
Practice Address - Country:US
Practice Address - Phone:209-981-6568
Practice Address - Fax:209-937-6408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-26
Last Update Date:2013-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health