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Organization
VICTORVILLE HHA SERVICES, LLC
Active
Organization
VICTORVILLE HHA SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. RAISA BANCHIK (OWNER)
(760) 241-5000
Entity
Organization
Contact information
Practice address
14075 HESPERIA RD, SUITE 204B, VICTORVILLE, CA 92395-4500
(760) 241-5000
Mailing address
14075 HESPERIA ROAD, 204B, VICTORVILLE, CA 92395-4500
(760) 241-5000
(760) 241-5073
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
550000027
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
550000027
DHS STATE LICENSE
CA
Enumeration date
11/03/2006
Last updated
10/25/2012
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