Provider Demographics
NPI:1902448368
Name:GREAT VALLEY HOME HEALTH LLC
Entity Type:Organization
Organization Name:GREAT VALLEY HOME HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ARMIDA
Authorized Official - Middle Name:
Authorized Official - Last Name:FAJARDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-229-8454
Mailing Address - Street 1:2730 NAGLEE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95304-7309
Mailing Address - Country:US
Mailing Address - Phone:209-229-8454
Mailing Address - Fax:
Practice Address - Street 1:2730 NAGLEE RD STE 200
Practice Address - Street 2:
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95304-7309
Practice Address - Country:US
Practice Address - Phone:209-229-8454
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-16
Last Update Date:2019-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health