Provider Demographics
NPI:1841591062
Name:UNITED NURSING PERSONAL CARE, INC
Entity Type:Organization
Organization Name:UNITED NURSING PERSONAL CARE, INC
Other - Org Name:GRACELIGHT HOMECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:CHAVARRIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-694-7345
Mailing Address - Street 1:11039 MESA LINDA ST
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92392-4812
Mailing Address - Country:US
Mailing Address - Phone:760-241-3800
Mailing Address - Fax:760-241-3855
Practice Address - Street 1:16044 BEAR VALLEY RD STE 5
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-8981
Practice Address - Country:US
Practice Address - Phone:760-241-3800
Practice Address - Fax:760-241-3855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-04
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1000163251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00697717OtherCNA