Provider Demographics
NPI:1457508152
Name:PERSONALIZED HOME HEALTH SERVICES
Entity Type:Organization
Organization Name:PERSONALIZED HOME HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SERVICE COORDINATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DALE
Authorized Official - Middle Name:E
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:650-288-2860
Mailing Address - Street 1:6200 STONERIDGE MALL RD
Mailing Address - Street 2:394
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94588-3242
Mailing Address - Country:US
Mailing Address - Phone:650-288-2860
Mailing Address - Fax:270-458-5725
Practice Address - Street 1:4060 HANDEL COMMON
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94536-6976
Practice Address - Country:US
Practice Address - Phone:650-288-2860
Practice Address - Fax:270-458-5725
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-25
Last Update Date:2008-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health