Provider Demographics
NPI:1710259130
Name:HOME SWEET HOME CARE OF SOUTHERN CALIFORNIA LLC
Entity Type:Organization
Organization Name:HOME SWEET HOME CARE OF SOUTHERN CALIFORNIA LLC
Other - Org Name:CHIROFIT PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICAL THERAPIST / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MITAS MOINA
Authorized Official - Middle Name:B
Authorized Official - Last Name:MEDRANO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:650-580-3503
Mailing Address - Street 1:8440 W THUNDERBIRD RD
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-4803
Mailing Address - Country:US
Mailing Address - Phone:623-773-2000
Mailing Address - Fax:623-776-2813
Practice Address - Street 1:8440 W THUNDERBIRD RD
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-4803
Practice Address - Country:US
Practice Address - Phone:623-773-2000
Practice Address - Fax:623-776-2813
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-31
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy