Provider Demographics
NPI:1659973469
Name:BASIC LIVING HOME CARE LLC
Entity Type:Organization
Organization Name:BASIC LIVING HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CALLISTUS
Authorized Official - Middle Name:E
Authorized Official - Last Name:AMAJOYI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-334-7172
Mailing Address - Street 1:222 E MAIN ST STE 216
Mailing Address - Street 2:
Mailing Address - City:BARSTOW
Mailing Address - State:CA
Mailing Address - Zip Code:92311-2366
Mailing Address - Country:US
Mailing Address - Phone:909-334-7172
Mailing Address - Fax:
Practice Address - Street 1:222 E MAIN ST STE 216
Practice Address - Street 2:
Practice Address - City:BARSTOW
Practice Address - State:CA
Practice Address - Zip Code:92311-2366
Practice Address - Country:US
Practice Address - Phone:909-334-7172
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-16
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care