Provider Demographics
NPI:1033654736
Name:ST. JOSEPH HEALTH PERSONAL CARE SERVICES
Entity Type:Organization
Organization Name:ST. JOSEPH HEALTH PERSONAL CARE SERVICES
Other - Org Name:PROVIDENCE HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-712-7094
Mailing Address - Street 1:200 W CENTER STREET PROMENADE STE 200A
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92805-3960
Mailing Address - Country:US
Mailing Address - Phone:714-712-7100
Mailing Address - Fax:
Practice Address - Street 1:200 W CENTER STREET PROMENADE
Practice Address - Street 2:SUITE 200
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92805-3960
Practice Address - Country:US
Practice Address - Phone:714-712-7100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-04
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA304700105253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care