Provider Demographics
NPI:1538197637
Name:SHOVA HEALTHCARE VNA, LLC
Entity type:Organization
Organization Name:SHOVA HEALTHCARE VNA, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDEN/ CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:KALI
Authorized Official - Middle Name:P
Authorized Official - Last Name:CHAUDHURI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-658-9288
Mailing Address - Street 1:890 W STETSON AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92543-7311
Mailing Address - Country:US
Mailing Address - Phone:951-658-9288
Mailing Address - Fax:951-765-6229
Practice Address - Street 1:890 W STETSON AVE
Practice Address - Street 2:SUITE A
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92543-7311
Practice Address - Country:US
Practice Address - Phone:951-658-9288
Practice Address - Fax:951-765-6229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-28
Last Update Date:2013-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA250000225251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHPC01531FMedicaid
CA051531Medicare Oscar/Certification