Provider Demographics
NPI:1730469271
Name:HOME CARE SPECTRUM LLC
Entity Type:Organization
Organization Name:HOME CARE SPECTRUM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ANGELITO
Authorized Official - Middle Name:DEMERIS
Authorized Official - Last Name:ROAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-667-0932
Mailing Address - Street 1:2973 HARBOR BLVD
Mailing Address - Street 2:SUITE 621
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-3912
Mailing Address - Country:US
Mailing Address - Phone:949-667-0942
Mailing Address - Fax:
Practice Address - Street 1:2973 HARBOR BLVD
Practice Address - Street 2:SUITE 621
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-3912
Practice Address - Country:US
Practice Address - Phone:949-667-0942
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-27
Last Update Date:2011-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health