Provider Demographics
NPI:1720539695
Name:HOME HEALTH OF CALIFORNIA LLC
Entity Type:Organization
Organization Name:HOME HEALTH OF CALIFORNIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:COBB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-598-7617
Mailing Address - Street 1:11 S SAN JOAQUIN ST
Mailing Address - Street 2:STE 506
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95202-3202
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11 S SAN JOAQUIN ST
Practice Address - Street 2:STE 506
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95202-3202
Practice Address - Country:US
Practice Address - Phone:209-598-7617
Practice Address - Fax:209-463-8035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-17
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health