Provider Demographics
NPI:1346249869
Name:SANTA CLARITA HOME HEALTH INC.
Entity Type:Organization
Organization Name:SANTA CLARITA HOME HEALTH INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:M
Authorized Official - Last Name:DEREK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-222-7889
Mailing Address - Street 1:22620 MARKET ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91321-3104
Mailing Address - Country:US
Mailing Address - Phone:661-222-7889
Mailing Address - Fax:661-222-7454
Practice Address - Street 1:23655 NEWHALL AVE
Practice Address - Street 2:SUITE A
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91321-3104
Practice Address - Country:US
Practice Address - Phone:661-222-7889
Practice Address - Fax:661-222-7454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-18
Last Update Date:2018-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA980001015251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHHA57722FMedicaid
CA557722Medicare Oscar/Certification