Provider Demographics
NPI:1962449074
Name:SANDERSON'S HEALTH SERVICES INC.
Entity Type:Organization
Organization Name:SANDERSON'S HEALTH SERVICES INC.
Other - Org Name:SANDERSON'S HOME HEALTH AGENCY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GALE
Authorized Official - Middle Name:E
Authorized Official - Last Name:SANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-375-4511
Mailing Address - Street 1:720 N NORMA ST STE E
Mailing Address - Street 2:
Mailing Address - City:RIDGECREST
Mailing Address - State:CA
Mailing Address - Zip Code:93555-3553
Mailing Address - Country:US
Mailing Address - Phone:760-375-4511
Mailing Address - Fax:760-375-4516
Practice Address - Street 1:720 N NORMA ST STE E
Practice Address - Street 2:
Practice Address - City:RIDGECREST
Practice Address - State:CA
Practice Address - Zip Code:93555-3553
Practice Address - Country:US
Practice Address - Phone:760-375-4511
Practice Address - Fax:760-375-4516
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-31
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA550000048251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA058320Medicare Oscar/Certification