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Organization
PROVISION HEALTHCARE SERVICES
Active
Organization
PROVISION HEALTHCARE SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SARAH LIZETTE CORNEJO (CEO)
(903) 705-2166
Entity
Organization
Contact information
Practice address
876 N MOUNTAIN AVE STE 200O, UPLAND, CA 91786-4166
(949) 353-9083
Mailing address
876 N MOUNTAIN AVE STE 200O, UPLAND, CA 91786-4166
(949) 353-9083
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C4832357
ARTICLES OF INCORPORATION
—
Enumeration date
02/14/2022
Last updated
02/14/2022
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