Provider Demographics
NPI:1437131778
Name:SELF-HELP FOR THE ELDERLY
Entity Type:Organization
Organization Name:SELF-HELP FOR THE ELDERLY
Other - Org Name:SELF-HELP HOMECARE & HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO & PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:ANNI
Authorized Official - Middle Name:
Authorized Official - Last Name:CHUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-677-7628
Mailing Address - Street 1:731 SANSOME ST
Mailing Address - Street 2:#100
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94111-1725
Mailing Address - Country:US
Mailing Address - Phone:415-677-7628
Mailing Address - Fax:415-398-5903
Practice Address - Street 1:731 SANSOME ST
Practice Address - Street 2:#100
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94111-1725
Practice Address - Country:US
Practice Address - Phone:415-677-7628
Practice Address - Fax:415-398-5903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-14
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA220000141251E00000X
CA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHHA70187FMedicaid
CA05-7570Medicare ID - Type UnspecifiedFOR HOME HEALTH