Provider Demographics
NPI:1639140346
Name:PROFESSIONAL NURSES GROUP, INC.
Entity Type:Organization
Organization Name:PROFESSIONAL NURSES GROUP, INC.
Other - Org Name:ALOHA HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:HERMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DJUHANA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-289-8999
Mailing Address - Street 1:13181 CROSSROADS PKWY N STE 322
Mailing Address - Street 2:
Mailing Address - City:CITY OF INDUSTRY
Mailing Address - State:CA
Mailing Address - Zip Code:91746-3461
Mailing Address - Country:US
Mailing Address - Phone:626-289-8999
Mailing Address - Fax:626-382-0888
Practice Address - Street 1:13181 CROSSROADS PKWY N STE 322
Practice Address - Street 2:
Practice Address - City:CITY OF INDUSTRY
Practice Address - State:CA
Practice Address - Zip Code:91746
Practice Address - Country:US
Practice Address - Phone:626-289-8999
Practice Address - Fax:626-382-0888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-30
Last Update Date:2019-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA980001335251E00000X
376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome HealthGroup - Single Specialty
No376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA058083Medicare ID - Type UnspecifiedHOME HEALTH SERVICES