Provider Demographics
NPI:1679951859
Name:SOUTH BAY HEALTHCARE, INC.
Entity Type:Organization
Organization Name:SOUTH BAY HEALTHCARE, INC.
Other - Org Name:SEQUOIA HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:LEE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-401-1369
Mailing Address - Street 1:830 HILLVIEW CT
Mailing Address - Street 2:SUITE 225
Mailing Address - City:MILPITAS
Mailing Address - State:CA
Mailing Address - Zip Code:95035-4550
Mailing Address - Country:US
Mailing Address - Phone:510-739-1992
Mailing Address - Fax:510-952-4264
Practice Address - Street 1:830 HILLVIEW CT
Practice Address - Street 2:SUITE 225
Practice Address - City:MILPITAS
Practice Address - State:CA
Practice Address - Zip Code:95035-4550
Practice Address - Country:US
Practice Address - Phone:510-739-1992
Practice Address - Fax:510-952-4264
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-08
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
058496Medicare PIN