Provider Demographics
NPI:1053708495
Name:VINEYARD HOME HEALTHCARE LLC
Entity type:Organization
Organization Name:VINEYARD HOME HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:O
Authorized Official - Last Name:IMONI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-987-0300
Mailing Address - Street 1:9605 ARROW RTE
Mailing Address - Street 2:SUITE S,
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-4555
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9605 ARROW RTE
Practice Address - Street 2:SUITE S,
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-4555
Practice Address - Country:US
Practice Address - Phone:909-987-0300
Practice Address - Fax:909-948-0300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-23
Last Update Date:2015-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health