Provider Demographics
NPI:1649290552
Name:FOOTHILL HOME CARE INC
Entity type:Organization
Organization Name:FOOTHILL HOME CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAPHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BAHREMAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-962-0242
Mailing Address - Street 1:12921 RAMONA BLVD
Mailing Address - Street 2:SUITE C
Mailing Address - City:IRWINDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91706-3748
Mailing Address - Country:US
Mailing Address - Phone:626-962-0242
Mailing Address - Fax:626-962-0249
Practice Address - Street 1:12921 RAMONA BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:IRWINDALE
Practice Address - State:CA
Practice Address - Zip Code:91706-3748
Practice Address - Country:US
Practice Address - Phone:626-962-0242
Practice Address - Fax:626-962-0249
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2009-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADME00813FMedicaid
CA0265790001Medicare NSC