Provider Demographics
NPI:1609300433
Name:TMH CLINIC AND HOME CARE
Entity Type:Organization
Organization Name:TMH CLINIC AND HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SERGE
Authorized Official - Middle Name:
Authorized Official - Last Name:BRONSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-326-9877
Mailing Address - Street 1:10400 VICTOR AVE UNIT 1
Mailing Address - Street 2:
Mailing Address - City:HESPERIA
Mailing Address - State:CA
Mailing Address - Zip Code:92345-2724
Mailing Address - Country:US
Mailing Address - Phone:714-326-9877
Mailing Address - Fax:
Practice Address - Street 1:10400 VICTOR AVE UNIT 1
Practice Address - Street 2:
Practice Address - City:HESPERIA
Practice Address - State:CA
Practice Address - Zip Code:92345-2724
Practice Address - Country:US
Practice Address - Phone:714-326-9877
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SEBRON
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-04-19
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization