Provider Demographics
NPI:1053440461
Name:HOME CARE MEDICAL SYSTEMS
Entity Type:Organization
Organization Name:HOME CARE MEDICAL SYSTEMS
Other - Org Name:HOME CARE PROVIDERS AND HOME CARE NURSES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT, CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:JEANNINE
Authorized Official - Middle Name:A
Authorized Official - Last Name:FITZGERALD
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BA, MA
Authorized Official - Phone:626-445-6558
Mailing Address - Street 1:PO BOX 11063
Mailing Address - Street 2:
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92821
Mailing Address - Country:US
Mailing Address - Phone:714-671-6877
Mailing Address - Fax:714-671-6801
Practice Address - Street 1:259 S. RANDOLPH AVE.
Practice Address - Street 2:#180 K
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821
Practice Address - Country:US
Practice Address - Phone:714-671-6877
Practice Address - Fax:714-671-6801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2015-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO980000776251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA980000776OtherDHS LICENSE #