Provider Demographics
NPI:1114794138
Name:FAMILY CARE HOSPICE & HOME HEALTH, INC.
Entity Type:Organization
Organization Name:FAMILY CARE HOSPICE & HOME HEALTH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:WILMER
Authorized Official - Middle Name:A
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-499-1701
Mailing Address - Street 1:1415 E 17TH ST STE 220E
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-8525
Mailing Address - Country:US
Mailing Address - Phone:714-395-8502
Mailing Address - Fax:888-365-4466
Practice Address - Street 1:1415 E 17TH ST STE 220E
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-8525
Practice Address - Country:US
Practice Address - Phone:714-499-1701
Practice Address - Fax:888-365-4466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-11
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No251E00000XAgenciesHome Health
No251G00000XAgenciesHospice Care, Community Based
No252Y00000XAgenciesEarly Intervention Provider Agency
No253Z00000XAgenciesIn Home Supportive Care
No305R00000XManaged Care OrganizationsPreferred Provider Organization
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332BD1200XSuppliersDurable Medical Equipment & Medical SuppliesDialysis Equipment & Supplies
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No385H00000XRespite Care FacilityRespite Care
No405300000XOther Service ProvidersPrevention Professional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1225805245Medicaid
CA1558138362Medicaid