Provider Demographics
NPI:1730481193
Name:VALLEY CARE HOME HEALTH, INC.
Entity Type:Organization
Organization Name:VALLEY CARE HOME HEALTH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:GILBERT
Authorized Official - Middle Name:C
Authorized Official - Last Name:MWANSA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:714-943-6454
Mailing Address - Street 1:353 E ANGELENO AVE
Mailing Address - Street 2:SUITE J
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91502-1310
Mailing Address - Country:US
Mailing Address - Phone:818-556-3611
Mailing Address - Fax:818-556-3630
Practice Address - Street 1:7077 ORANGEWOOD AVE STE 100
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92841-1426
Practice Address - Country:US
Practice Address - Phone:714-379-0102
Practice Address - Fax:714-379-0117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-17
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA550001629251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA059411Medicare Oscar/Certification