Provider Demographics
NPI:1609863547
Name:MULTI-SKILLED HOME CARE SERVICES, INC.
Entity type:Organization
Organization Name:MULTI-SKILLED HOME CARE SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR DPCS
Authorized Official - Prefix:MS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:BRENDA
Authorized Official - Last Name:ILAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:909-595-0200
Mailing Address - Street 1:19608 CAMINO DE ROSA
Mailing Address - Street 2:
Mailing Address - City:WALNUT
Mailing Address - State:CA
Mailing Address - Zip Code:91789-2103
Mailing Address - Country:US
Mailing Address - Phone:909-595-0200
Mailing Address - Fax:909-595-1211
Practice Address - Street 1:19608 CAMINO DE ROSA
Practice Address - Street 2:
Practice Address - City:WALNUT
Practice Address - State:CA
Practice Address - Zip Code:91789-2103
Practice Address - Country:US
Practice Address - Phone:909-595-0200
Practice Address - Fax:909-595-1211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHHA08198FMedicaid
CA058198Medicare ID - Type UnspecifiedHOME HEALTH PROVIDER NO.