Provider Demographics
NPI:1487657235
Name:ANTELOPE VALLEY HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:ANTELOPE VALLEY HOSPITAL DISTRICT
Other - Org Name:ANTELOPE VALLEY HOME CARE
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:PATTI
Authorized Official - Middle Name:
Authorized Official - Last Name:SHELDON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:661-949-5938
Mailing Address - Street 1:44335 LOWTREE AVE
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534-4167
Mailing Address - Country:US
Mailing Address - Phone:661-949-5938
Mailing Address - Fax:661-951-4248
Practice Address - Street 1:44335 LOWTREE AVE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-4167
Practice Address - Country:US
Practice Address - Phone:661-949-5938
Practice Address - Fax:661-951-4248
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-24
Last Update Date:2008-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHHA07786FMedicaid
CA057786Medicare ID - Type Unspecified