Provider Demographics
NPI:1609159110
Name:PEPPERMINT HOLDINGS LLC
Entity Type:Organization
Organization Name:PEPPERMINT HOLDINGS LLC
Other - Org Name:INTERLINK HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:BALLIF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-471-0388
Mailing Address - Street 1:100 E. SAN MARCOS BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92069
Mailing Address - Country:US
Mailing Address - Phone:760-471-0388
Mailing Address - Fax:760-471-0311
Practice Address - Street 1:2501 LA HABRA BLVD
Practice Address - Street 2:SUITE 4
Practice Address - City:LA HABRA
Practice Address - State:CA
Practice Address - Zip Code:90631
Practice Address - Country:US
Practice Address - Phone:760-471-0388
Practice Address - Fax:760-471-0311
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PEPPERMINT HOLDINGS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-09-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
058098Medicare Oscar/Certification