Provider Demographics
NPI:1609012079
Name:COMPLETE PHLEBOTOMY TRAINING, INC.
Entity Type:Organization
Organization Name:COMPLETE PHLEBOTOMY TRAINING, INC.
Other - Org Name:CPT HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:WANDA
Authorized Official - Middle Name:KIM
Authorized Official - Last Name:TARDY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:909-214-5909
Mailing Address - Street 1:44937 CLARO RD
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92544-6744
Mailing Address - Country:US
Mailing Address - Phone:909-214-5909
Mailing Address - Fax:
Practice Address - Street 1:44937 CLARO RD
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92544-6744
Practice Address - Country:US
Practice Address - Phone:909-214-5909
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMPLETE PHLEBOTOMY TRAINING,INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-01-06
Last Update Date:2009-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN467742163W00000X, 163WH0200X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty
No163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty