Provider Demographics
NPI:1639100381
Name:ST. JOHN HOME HEALTH CARE SERVICES, INC.
Entity Type:Organization
Organization Name:ST. JOHN HOME HEALTH CARE SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO/OFFICE MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:R
Authorized Official - Last Name:OLLET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-795-3429
Mailing Address - Street 1:2500 E. FOOTHILL BLVD.
Mailing Address - Street 2:SUITE 102
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91107
Mailing Address - Country:US
Mailing Address - Phone:626-795-3429
Mailing Address - Fax:
Practice Address - Street 1:2500 E. FOOTHILL BLVD.
Practice Address - Street 2:SUITE 102
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91107
Practice Address - Country:US
Practice Address - Phone:626-795-3429
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA058260Medicare ID - Type Unspecified