Provider Demographics
NPI:1336178292
Name:STOVALL WILSON HOME CARE
Entity Type:Organization
Organization Name:STOVALL WILSON HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:DENNIESE
Authorized Official - Last Name:STOVALL WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:LVN
Authorized Official - Phone:661-273-3755
Mailing Address - Street 1:190 SIERRA CT
Mailing Address - Street 2:STE. B 217
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93550-7607
Mailing Address - Country:US
Mailing Address - Phone:661-273-3755
Mailing Address - Fax:661-273-3755
Practice Address - Street 1:190 SIERRA CT
Practice Address - Street 2:STE. B 217
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93550-7607
Practice Address - Country:US
Practice Address - Phone:661-273-3755
Practice Address - Fax:661-273-3755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered251E00000XAgenciesHome Health
Not Answered251G00000XAgenciesHospice Care, Community Based
Not Answered251J00000XAgenciesNursing Care
Not Answered347C00000XTransportation ServicesPrivate Vehicle