Basic Information
| Provider Information | |||||||||
| NPI: | 1750531372 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SAN DIEGO HOME HEALTH CARE SERVICES, INC. | ||||||||
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| OtherOrganizationName: | SAN DIEGO HOME HEALTH CARE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3340 TULLY RD | ||||||||
| Address2: | SUITE C-8A | ||||||||
| City: | MODESTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953500838 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2095248700 | ||||||||
| FaxNumber: | 2095248701 | ||||||||
| Practice Location | |||||||||
| Address1: | 511 ENCINITAS BOULEVARD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | ENCINITAS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920243778 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7604367344 | ||||||||
| FaxNumber: | 7604364346 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/19/2008 | ||||||||
| LastUpdateDate: | 11/26/2013 | ||||||||
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| AuthorizedOfficialLastName: | O'SULLIVAN | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
| AuthorizedOfficialMiddleName: | VINCENT | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER, SEC./TREAS. | ||||||||
| AuthorizedOfficialTelephone: | 2095248700 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | JR. | ||||||||
| AuthorizedOfficialCredential: | PT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | N | Agencies | Home Health | 251E00000X | 550001041 | CA | Y | Agencies | Home Health |
No ID Information.