Provider Demographics
NPI:1801554258
Name:SENIOR HOME CAREGIVERS, INC.
Entity type:Organization
Organization Name:SENIOR HOME CAREGIVERS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-835-5626
Mailing Address - Street 1:1003 E COOLEY DR STE 203
Mailing Address - Street 2:
Mailing Address - City:COLTON
Mailing Address - State:CA
Mailing Address - Zip Code:92324-3907
Mailing Address - Country:US
Mailing Address - Phone:909-867-7787
Mailing Address - Fax:909-872-1168
Practice Address - Street 1:1003 E COOLEY DR STE 203
Practice Address - Street 2:
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-3907
Practice Address - Country:US
Practice Address - Phone:909-867-7787
Practice Address - Fax:909-872-1168
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-02
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADSS-364700007OtherLICENSE