Avicenna Home Care Agency LLC

Primary specialty

In Home Supportive Care AgencyTaxonomy code 253Z00000X

Legal business name

AVICENNA HOME CARE AGENCY LLC

Practice address

8273 White Oak Ave Ste P
Rancho Cucamonga, CA 91730-7671

Phone

(909) 329-2699

NPI assigned

Nov 21, 2021

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Abdoullah Kabbaj

Title

Owner

Phone

(909) 319-7475

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1637452800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1637452800000",
    "number": "1003573304",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8273 WHITE OAK AVE STE P",
            "city": "RANCHO CUCAMONGA",
            "state": "CA",
            "postal_code": "917307671",
            "telephone_number": "909-329-2699"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8273 WHITE OAK AVE STE P",
            "city": "RANCHO CUCAMONGA",
            "state": "CA",
            "postal_code": "917307671",
            "telephone_number": "909-329-2699"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AVICENNA HOME CARE AGENCY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-11-21",
        "last_updated": "2021-11-21",
        "certification_date": "2021-11-21",
        "status": "A",
        "authorized_official_last_name": "KABBAJ",
        "authorized_official_first_name": "ABDOULLAH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "909-319-7475"
    },
    "taxonomies": [
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CDSS - HOME CARE SERVICES BUREAU",
            "identifier": "364700107",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• In Home Supportive Care Agency in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.