Provider Demographics
NPI:1396010864
Name:FOG CITY HOME HEALTH
Entity Type:Organization
Organization Name:FOG CITY HOME HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:L
Authorized Official - Last Name:SCHULKIN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:415-515-2204
Mailing Address - Street 1:595 BUCKINGHAM WAY STE 317
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94132-1911
Mailing Address - Country:US
Mailing Address - Phone:415-515-2204
Mailing Address - Fax:
Practice Address - Street 1:595 BUCKINGHAM WAY STE 317
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94132-1911
Practice Address - Country:US
Practice Address - Phone:415-515-2204
Practice Address - Fax:415-665-2775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-17
Last Update Date:2012-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251E0000X251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health