Provider Demographics
NPI:1083709919
Name:ST. JOSEPH HOME CARE NETWORK
Entity Type:Organization
Organization Name:ST. JOSEPH HOME CARE NETWORK
Other - Org Name:ST. JOSEPH HEALTH - HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INTERIM EXECUTIVE DI
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:R
Authorized Official - Last Name:SAMPLES
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:707-575-6601
Mailing Address - Street 1:1165 MONTGOMERY DRIVE
Mailing Address - Street 2:MS 1S13
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95405
Mailing Address - Country:US
Mailing Address - Phone:707-206-9124
Mailing Address - Fax:707-206-9421
Practice Address - Street 1:980 TRANCAS STREET
Practice Address - Street 2:SUITE 9
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558
Practice Address - Country:US
Practice Address - Phone:707-257-4724
Practice Address - Fax:707-224-7087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2013-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA010000127251E00000X, 251F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251F00000XAgenciesHome Infusion
Provider Identifiers
StateIdentifier IDID TypeIssuer
HHA07659GOtherMEDI-CAL
CAHHA07659GMedicaid
HHA07659GOtherMEDI-CAL