Provider Demographics
NPI:1871629600
Name:SAN MARINO HOME HEALTH INC
Entity Type:Organization
Organization Name:SAN MARINO HOME HEALTH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:TINH
Authorized Official - Middle Name:VAN
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-584-0635
Mailing Address - Street 1:2233 HUNTINGTON DR
Mailing Address - Street 2:SUITE 3
Mailing Address - City:SAN MARINO
Mailing Address - State:CA
Mailing Address - Zip Code:91108-2655
Mailing Address - Country:US
Mailing Address - Phone:626-584-0635
Mailing Address - Fax:626-584-0636
Practice Address - Street 1:2233 HUNTINGTON DR
Practice Address - Street 2:SUITE 3
Practice Address - City:SAN MARINO
Practice Address - State:CA
Practice Address - Zip Code:91108-2655
Practice Address - Country:US
Practice Address - Phone:626-584-0635
Practice Address - Fax:626-584-0636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA980001066251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA058030Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER