Provider Demographics
NPI:1922406248
Name:SAN BERNARDINO HOME HEALTHCARE, INC
Entity Type:Organization
Organization Name:SAN BERNARDINO HOME HEALTHCARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:EDNA
Authorized Official - Middle Name:
Authorized Official - Last Name:MADATYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-530-9717
Mailing Address - Street 1:1117 N HOLLYWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-2528
Mailing Address - Country:US
Mailing Address - Phone:888-530-9717
Mailing Address - Fax:888-530-9705
Practice Address - Street 1:1117 N HOLLYWOOD WAY
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-2528
Practice Address - Country:US
Practice Address - Phone:888-530-9717
Practice Address - Fax:888-530-9705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-18
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health