Provider Demographics
NPI:1083881569
Name:SAN DIEGO HOME HEALTH CARE AGENCY,LLC
Entity Type:Organization
Organization Name:SAN DIEGO HOME HEALTH CARE AGENCY,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:HEWITT
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:760-613-4974
Mailing Address - Street 1:6937 WATERS END DR
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92011-3253
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4407 MANCHESTER AVE STE 102
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-4941
Practice Address - Country:US
Practice Address - Phone:760-613-4974
Practice Address - Fax:760-438-8648
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-13
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health