Provider Demographics
NPI:1477661601
Name:NU-ERA HOME HEALTH AGENCY, INC
Entity type:Organization
Organization Name:NU-ERA HOME HEALTH AGENCY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BARRINGTON
Authorized Official - Middle Name:FITZGERALD
Authorized Official - Last Name:RICHARDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-890-9111
Mailing Address - Street 1:1822 E. ROUTE 66
Mailing Address - Street 2:SUITE A PMB 213
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91740-3800
Mailing Address - Country:US
Mailing Address - Phone:909-890-9111
Mailing Address - Fax:310-973-6361
Practice Address - Street 1:29000 S WESTERN AVE STE 207
Practice Address - Street 2:
Practice Address - City:RANCHO PALOS VERDES
Practice Address - State:CA
Practice Address - Zip Code:90275-0890
Practice Address - Country:US
Practice Address - Phone:909-890-9111
Practice Address - Fax:310-973-6361
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-28
Last Update Date:2018-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA980001475251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1477661601Medicaid
CA058222Medicare PIN