Provider Demographics
NPI:1669815064
Name:MEDCARE PLUS HOME HEALTH PROVIDERS, INC.
Entity Type:Organization
Organization Name:MEDCARE PLUS HOME HEALTH PROVIDERS, INC.
Other - Org Name:BLUE DIAMOND HOME HEALTH PROVIDER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO/SECRETARY
Authorized Official - Prefix:MR
Authorized Official - First Name:NELSON
Authorized Official - Middle Name:N
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-594-4990
Mailing Address - Street 1:870 N MOUNTAIN AVE STE 123
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-4173
Mailing Address - Country:US
Mailing Address - Phone:626-594-4990
Mailing Address - Fax:877-289-9698
Practice Address - Street 1:1135 E ROUTE 66 STE 209
Practice Address - Street 2:
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91740-3778
Practice Address - Country:US
Practice Address - Phone:626-594-4990
Practice Address - Fax:877-289-9698
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-16
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC2519247251E00000X
251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health