Basic Information
| Provider Information | |||||||||
| NPI: | 1609159110 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | PEPPERMINT HOLDINGS LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | INTERLINK HOME HEALTH | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 E. SAN MARCOS BLVD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | SAN MARCOS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92069 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7604710388 | ||||||||
| FaxNumber: | 7604710311 | ||||||||
| Practice Location | |||||||||
| Address1: | 2501 LA HABRA BLVD | ||||||||
| Address2: | SUITE 4 | ||||||||
| City: | LA HABRA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 90631 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7604710388 | ||||||||
| FaxNumber: | 7604710311 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/21/2011 | ||||||||
| LastUpdateDate: | 09/21/2011 | ||||||||
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| AuthorizedOfficialLastName: | BALLIF | ||||||||
| AuthorizedOfficialFirstName: | MARK | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 7604710388 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | PEPPERMINT HOLDINGS LLC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | CA | Y | Agencies | Home Health |
No ID Information.