# DIRECT PROVIDER OF HEALTHCARE SERVICES, INC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1003056292
- **Authorized official:** SUSAN PANGANIBAN RN (CHIEF EXECUTIVE OFFICER)
- **Authorized official phone:** (909) 483-8311

## Contact information

- **Practice address:** 9320 BASE LINE RD STE B, RANCHO CUCAMONGA, CA 91701-5829
- **Practice address phone:** (909) 483-8311
- **Practice address fax:** (909) 483-8382
- **Mailing address:** 9320 BASE LINE RD STE B, RANCHO CUCAMONGA, CA 91701-5829
- **Mailing address phone:** (909) 483-8311
- **Mailing address fax:** (909) 483-8382

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251E00000X | Home Health Agency | — | CA | Yes |

## Other

- **Enumeration date:** 02/27/2009
- **Last updated:** 09/16/2025