Provider Demographics
NPI:1629219902
Name:PROFESSIONAL NURSES HOMEHEALTH LLC
Entity Type:Organization
Organization Name:PROFESSIONAL NURSES HOMEHEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATING MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:M ELVA
Authorized Official - Middle Name:DELL
Authorized Official - Last Name:HUFF
Authorized Official - Suffix:
Authorized Official - Credentials:LVN
Authorized Official - Phone:909-518-8469
Mailing Address - Street 1:1740 N PRIMROSE AVE
Mailing Address - Street 2:
Mailing Address - City:RIALTO
Mailing Address - State:CA
Mailing Address - Zip Code:92376-2933
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2037 N D ST STE 109
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92405-3936
Practice Address - Country:US
Practice Address - Phone:909-518-8469
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-16
Last Update Date:2009-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health