Provider Demographics
NPI:1790109908
Name:HEALTHY HOME HEALTH
Entity Type:Organization
Organization Name:HEALTHY HOME HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES/CEO/CFO/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:JUDAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-235-7355
Mailing Address - Street 1:13391 CALIFORNIA ST
Mailing Address - Street 2:
Mailing Address - City:YUCAIPA
Mailing Address - State:CA
Mailing Address - Zip Code:92399-5105
Mailing Address - Country:US
Mailing Address - Phone:909-235-7355
Mailing Address - Fax:909-217-7184
Practice Address - Street 1:13391 CALIFORNIA ST
Practice Address - Street 2:
Practice Address - City:YUCAIPA
Practice Address - State:CA
Practice Address - Zip Code:92399-5105
Practice Address - Country:US
Practice Address - Phone:909-235-7355
Practice Address - Fax:909-217-7184
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-07
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities