Provider Demographics
NPI:1033559356
Name:MEMORIALCARE HOME HEALTH - LLC
Entity Type:Organization
Organization Name:MEMORIALCARE HOME HEALTH - LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:ADOLFO
Authorized Official - Middle Name:OSCAR
Authorized Official - Last Name:CHANEZ
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:949-452-3644
Mailing Address - Street 1:23521 PASEO DE VALENCIA STE 100
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-3126
Mailing Address - Country:US
Mailing Address - Phone:949-452-3626
Mailing Address - Fax:949-452-3460
Practice Address - Street 1:23521 PASEO DE VALENCIA STE 100
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-3126
Practice Address - Country:US
Practice Address - Phone:949-452-3626
Practice Address - Fax:949-452-3460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-01
Last Update Date:2013-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA060000218251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health