Organization Name: | PRUDENTIAL HEALTH SYSTEMS |
NPI Number: | 1174894240 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JOSE PEREZ (CFO) |
Mailing Address: | 1440 Flower St Ste B Glendale |
State: | CA US |
Postal Code: | 912012422 |
Phone Number: | 3108479341 |
Fax Number: | |
NPI Enumeration Date: | 01/22/2012 |
NPI Last Update Date: | 01/22/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 251G00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Agencies |
Taxonomy Classification: | Hospice Care, Community Based |
Taxonomy Specialization: | |
Taxonomy Definition: |