Provider Demographics
NPI:1356844096
Name:ST. FRANCIS HOME HEALTH AGENCY, INC.
Entity Type:Organization
Organization Name:ST. FRANCIS HOME HEALTH AGENCY, INC.
Other - Org Name:ST. FRANCIS HOME HEALTH AGENCY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:AIYETIWA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-989-7700
Mailing Address - Street 1:10970 ARROW RTE STE 206
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-4839
Mailing Address - Country:US
Mailing Address - Phone:909-989-5383
Mailing Address - Fax:909-457-6353
Practice Address - Street 1:10970 ARROW RTE STE 205
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-4839
Practice Address - Country:US
Practice Address - Phone:909-989-7700
Practice Address - Fax:909-457-6353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-08
Last Update Date:2020-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251E00000X
251F00000X, 251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251F00000XAgenciesHome Infusion
No251J00000XAgenciesNursing Care