Provider Demographics
NPI:1568507507
Name:SANTA RITA HOME CARE INC.
Entity Type:Organization
Organization Name:SANTA RITA HOME CARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:D
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-989-1409
Mailing Address - Street 1:2770 S MARYLAND PKWY
Mailing Address - Street 2:STE 203
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89109-1565
Mailing Address - Country:US
Mailing Address - Phone:702-893-1023
Mailing Address - Fax:702-893-0769
Practice Address - Street 1:2770 S MARYLAND PKWY
Practice Address - Street 2:STE 203
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89109-1565
Practice Address - Country:US
Practice Address - Phone:702-893-1023
Practice Address - Fax:702-893-0769
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2009-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4723HHA-2251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV297151Medicare Oscar/Certification