Basic Information
| Provider Information | |||||||||
| NPI: | 1427205434 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SAN DIEGO HOME HEALTH CARE AGENCY, INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | SAN DIEGO HOME HEALTH CARE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 511 ENCINITAS BLVD STE 100 | ||||||||
| Address2: | |||||||||
| City: | ENCINITAS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920243778 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7604367344 | ||||||||
| FaxNumber: | 7604367346 | ||||||||
| Practice Location | |||||||||
| Address1: | 511 ENCINITAS BLVD STE 100 | ||||||||
| Address2: | |||||||||
| City: | ENCINITAS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920243778 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7604367344 | ||||||||
| FaxNumber: | 7604367346 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/20/2008 | ||||||||
| LastUpdateDate: | 08/20/2008 | ||||||||
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| AuthorizedOfficialLastName: | HEWITT | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
| AuthorizedOfficialMiddleName: | THOMAS | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7604367344 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNameSuffix: | JR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | Y | Agencies | Home Health |
No ID Information.