Provider Demographics
NPI:1699396655
Name:ST. JOSEPH HEALTH SYSTEM HOME CARE SERVICES LLC
Entity Type:Organization
Organization Name:ST. JOSEPH HEALTH SYSTEM HOME CARE SERVICES LLC
Other - Org Name:PROVIDENCE HOME INFUSION ORANGE COUNTY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSISTANT SECRETARY FOR ENROLLMENT
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:425-525-5392
Mailing Address - Street 1:PO BOX 31001-1965
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91110-9165
Mailing Address - Country:US
Mailing Address - Phone:714-712-9500
Mailing Address - Fax:714-712-9535
Practice Address - Street 1:200 W CENTER STREET PROMENADE STE 100A
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92805-3960
Practice Address - Country:US
Practice Address - Phone:844-983-0647
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-30
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No333600000XSuppliersPharmacy