Provider Demographics
NPI:1861634115
Name:SUNCREST HOME HEALTH SERVICES, INC.
Entity Type:Organization
Organization Name:SUNCREST HOME HEALTH SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ESTELITA
Authorized Official - Middle Name:A
Authorized Official - Last Name:DE LEON
Authorized Official - Suffix:
Authorized Official - Credentials:RN BSN MA
Authorized Official - Phone:909-399-1122
Mailing Address - Street 1:4959 PALO VERDE ST
Mailing Address - Street 2:SUITE # 206A-2
Mailing Address - City:MONTCLAIR
Mailing Address - State:CA
Mailing Address - Zip Code:91763-2331
Mailing Address - Country:US
Mailing Address - Phone:909-399-1122
Mailing Address - Fax:909-399-1115
Practice Address - Street 1:4959 PALO VERDE ST
Practice Address - Street 2:SUITE # 206A-2
Practice Address - City:MONTCLAIR
Practice Address - State:CA
Practice Address - Zip Code:91763-2331
Practice Address - Country:US
Practice Address - Phone:909-399-1122
Practice Address - Fax:909-399-1115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-01
Last Update Date:2009-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health