Provider Demographics
NPI:1770741241
Name:ROGER'S HOME, INC.
Entity type:Organization
Organization Name:ROGER'S HOME, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ALFREDO
Authorized Official - Middle Name:MENDOZA
Authorized Official - Last Name:ILAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-733-0762
Mailing Address - Street 1:9835 WILEY BURKE AVE
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90240-3713
Mailing Address - Country:US
Mailing Address - Phone:562-927-8043
Mailing Address - Fax:951-658-1840
Practice Address - Street 1:27180 ROGER ST
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92544-8312
Practice Address - Country:US
Practice Address - Phone:951-652-9712
Practice Address - Fax:951-658-1840
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-30
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities