Provider Demographics
NPI:1346792488
Name:ON MY OWN INDEPENDENT LIVING SERVICES
Entity Type:Organization
Organization Name:ON MY OWN INDEPENDENT LIVING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMIREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-726-0792
Mailing Address - Street 1:6939 SUNRISE BLVD
Mailing Address - Street 2:SUITE 215
Mailing Address - City:CITRUS HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:95610-3153
Mailing Address - Country:US
Mailing Address - Phone:916-726-0792
Mailing Address - Fax:
Practice Address - Street 1:6939 SUNRISE BLVD
Practice Address - Street 2:SUITE 215
Practice Address - City:CITRUS HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:95610-3153
Practice Address - Country:US
Practice Address - Phone:916-726-0792
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-25
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251C00000X, 251G00000X, 251J00000X
CA253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251G00000XAgenciesHospice Care, Community Based
No251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA2407772OtherCOMPANY CORPORATION NUMBER
CA347004697OtherRCFE CARE HOME LICENSE
CAGEN-05336OtherCALIFORNIA BUSINESS LICENSE