Provider Demographics
NPI:1154630853
Name:EGEMO HOME HEALTH SERVICE
Entity Type:Organization
Organization Name:EGEMO HOME HEALTH SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:EGEMO
Authorized Official - Suffix:
Authorized Official - Credentials:AA MEDICAL MANAGMENT
Authorized Official - Phone:760-754-7093
Mailing Address - Street 1:1201 SEA CLIFF WAY
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92056-2828
Mailing Address - Country:US
Mailing Address - Phone:760-754-7093
Mailing Address - Fax:760-754-2053
Practice Address - Street 1:1201 SEA CLIFF WAY
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92056-2828
Practice Address - Country:US
Practice Address - Phone:760-754-7093
Practice Address - Fax:760-754-2053
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-28
Last Update Date:2010-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA110810251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health