Provider Demographics
NPI:1639897408
Name:ST GEORGE HEALTHCARE AGENCY, INC.
Entity Type:Organization
Organization Name:ST GEORGE HEALTHCARE AGENCY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:SY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-369-1546
Mailing Address - Street 1:14545 FRIAR ST STE 224
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91411-4719
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14545 FRIAR ST STE 224
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91411-4719
Practice Address - Country:US
Practice Address - Phone:818-945-8343
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-18
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health