Provider Demographics
NPI:1952077471
Name:SG HOMECARE, INC.
Entity Type:Organization
Organization Name:SG HOMECARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDRIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HREN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-355-3675
Mailing Address - Street 1:345 MCCORMICK AVE
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-3422
Mailing Address - Country:US
Mailing Address - Phone:949-355-3675
Mailing Address - Fax:
Practice Address - Street 1:642 S WATERMAN AVE
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-2330
Practice Address - Country:US
Practice Address - Phone:909-435-2345
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-17
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies