Provision Healthcare Services

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

Legal business name

PROVISION HEALTHCARE SERVICES

Practice address

876 N Mountain Ave Ste 200O
Upland, CA 91786-4166

Phone

(949) 353-9083

NPI assigned

Feb 14, 2022

Organization subpart

No

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

Authorized official

Name

Sarah Lizette Cornejo

Title

Ceo

Phone

(903) 705-2166

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1644796800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1644796800000",
    "number": "1649925140",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "876 N MOUNTAIN AVE STE 200O",
            "city": "UPLAND",
            "state": "CA",
            "postal_code": "917864166",
            "telephone_number": "949-353-9083"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "876 N MOUNTAIN AVE STE 200O",
            "city": "UPLAND",
            "state": "CA",
            "postal_code": "917864166",
            "telephone_number": "949-353-9083"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVISION HEALTHCARE SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-02-14",
        "last_updated": "2022-02-14",
        "certification_date": "2022-02-14",
        "status": "A",
        "authorized_official_last_name": "CORNEJO",
        "authorized_official_first_name": "SARAH LIZETTE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "903-705-2166"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ARTICLES OF INCORPORATION",
            "identifier": "C4832357",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Britni Lynn, Nicole Proulx
• Robert E. Proulx, MFT
• Julia Mari Provens
• Providence Respite Inc
• Provision Care Hospice Inc
• Aimee Provost
• Ashley D. Prueitt, PSYD
• Psalm71:9 LLC
• Psychotherapy Solutions
• Diane Puchbauer, PSYD

• Home Health Agency in Upland, CA
• Providers in Upland, CA by specialty
• Home Health Agency in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2022; 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.