Provider Demographics
NPI:1649405945
Name:DEFAIT HOME CARE SERVICES
Entity Type:Organization
Organization Name:DEFAIT HOME CARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MRS
Authorized Official - First Name:ETHEL
Authorized Official - Middle Name:N
Authorized Official - Last Name:NWANDU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-533-8975
Mailing Address - Street 1:3300 W ROSECRANS AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:HAWTHORNE
Mailing Address - State:CA
Mailing Address - Zip Code:90250-8218
Mailing Address - Country:US
Mailing Address - Phone:310-644-4499
Mailing Address - Fax:310-327-2881
Practice Address - Street 1:3300 W ROSECRANS AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250-8218
Practice Address - Country:US
Practice Address - Phone:310-644-4499
Practice Address - Fax:310-327-2881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-16
Last Update Date:2009-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health