Provider Demographics
NPI:1205835873
Name:SELECT CARE HOME HEALTH SERVICES, INC.
Entity Type:Organization
Organization Name:SELECT CARE HOME HEALTH SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:EVELYN
Authorized Official - Middle Name:DOMINGO
Authorized Official - Last Name:NOBLEJAS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:818-885-8378
Mailing Address - Street 1:20201 SHERMAN WAY
Mailing Address - Street 2:SUITE 204
Mailing Address - City:CANOGA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91306-3269
Mailing Address - Country:US
Mailing Address - Phone:818-885-8378
Mailing Address - Fax:818-885-5891
Practice Address - Street 1:20201 SHERMAN WAY
Practice Address - Street 2:SUITE 204
Practice Address - City:CANOGA PARK
Practice Address - State:CA
Practice Address - Zip Code:91306-3269
Practice Address - Country:US
Practice Address - Phone:818-885-8378
Practice Address - Fax:818-885-5891
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-18
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA058219Medicare ID - Type UnspecifiedPROVIDER NUMBER