Provider Demographics
NPI:1770237232
Name:PUBLIC IN-HOME SUPPORT SERVICES AUTHORITY
Entity Type:Organization
Organization Name:PUBLIC IN-HOME SUPPORT SERVICES AUTHORITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:HUNTER
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:305-923-8312
Mailing Address - Street 1:32295 MISSION TRL # 8-312
Mailing Address - Street 2:
Mailing Address - City:LAKE ELSINORE
Mailing Address - State:CA
Mailing Address - Zip Code:92530-2305
Mailing Address - Country:US
Mailing Address - Phone:305-923-8312
Mailing Address - Fax:
Practice Address - Street 1:9325 APPLETON ST # 79
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92392-1843
Practice Address - Country:US
Practice Address - Phone:310-283-6720
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-03
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No174200000XOther Service ProvidersMeals
No177F00000XOther Service ProvidersLodging
No251B00000XAgenciesCase Management
No251V00000XAgenciesVoluntary or Charitable