Provider Demographics
NPI:1154314201
Name:ST. CLARE'S HOME CARE, INC.
Entity Type:Organization
Organization Name:ST. CLARE'S HOME CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:MAGABILIN
Authorized Official - Last Name:MANUG
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:714-638-9700
Mailing Address - Street 1:12912 BROOKHURST ST
Mailing Address - Street 2:SUITE 402
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92840-4835
Mailing Address - Country:US
Mailing Address - Phone:714-638-9700
Mailing Address - Fax:714-638-9000
Practice Address - Street 1:12912 BROOKHURST ST
Practice Address - Street 2:SUITE 402
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92840-4835
Practice Address - Country:US
Practice Address - Phone:714-638-9700
Practice Address - Fax:714-638-9000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-24
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA060000774251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA05-8086Medicare ID - Type UnspecifiedHOME HEALTH