Provider Demographics
NPI:1063025633
Name:SEPULVEDA HOME NURSING CARE CORP.
Entity Type:Organization
Organization Name:SEPULVEDA HOME NURSING CARE CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER /CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:SEPULVEDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:855-922-7323
Mailing Address - Street 1:2734 GOLF MEADOWS CT
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93063-2472
Mailing Address - Country:US
Mailing Address - Phone:855-922-7323
Mailing Address - Fax:
Practice Address - Street 1:2734 GOLF MEADOWS CT
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93063-2472
Practice Address - Country:US
Practice Address - Phone:855-922-7323
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-24
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
No251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care
No3140N1450XNursing & Custodial Care FacilitiesSkilled Nursing FacilityNursing Care, Pediatric
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child