Provider Demographics
NPI:1639671431
Name:TERICARE HOME HEALTH SERVICES, LLC
Entity Type:Organization
Organization Name:TERICARE HOME HEALTH SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:SERRANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-233-3475
Mailing Address - Street 1:2103 REDWOOD ST STE 206
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94590-3608
Mailing Address - Country:US
Mailing Address - Phone:707-654-9907
Mailing Address - Fax:877-406-6515
Practice Address - Street 1:2103 REDWOOD ST STE 206
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94590-3608
Practice Address - Country:US
Practice Address - Phone:707-654-9907
Practice Address - Fax:877-406-6515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-07
Last Update Date:2019-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health