Provider Demographics
NPI:1104223825
Name:JADE SPECIALTY HOME HEALTH CARE
Entity type:Organization
Organization Name:JADE SPECIALTY HOME HEALTH CARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CHANTAL
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:BANON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:714-797-1153
Mailing Address - Street 1:828 W JADE WAY
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92805-2420
Mailing Address - Country:US
Mailing Address - Phone:714-797-1153
Mailing Address - Fax:
Practice Address - Street 1:828 W JADE WAY
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92805-2420
Practice Address - Country:US
Practice Address - Phone:714-797-1153
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JADE SPECIALTY HOME HEALTH CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-11-24
Last Update Date:2014-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN760661251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health