Provider Demographics
NPI:1053852194
Name:SG HOMECARE, INC
Entity Type:Organization
Organization Name:SG HOMECARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:R
Authorized Official - Last Name:ROWLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-474-2050
Mailing Address - Street 1:345 MCCORMICK AVE
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-3422
Mailing Address - Country:US
Mailing Address - Phone:949-474-2050
Mailing Address - Fax:949-474-4460
Practice Address - Street 1:12380 HESPERIA RD
Practice Address - Street 2:#1
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-5814
Practice Address - Country:US
Practice Address - Phone:949-474-2050
Practice Address - Fax:949-474-4460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-08
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies