Provider Demographics
NPI:1972942043
Name:ST. MARY'S HOME HEALTH SERVICES LLC
Entity Type:Organization
Organization Name:ST. MARY'S HOME HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SAJIMON
Authorized Official - Middle Name:P
Authorized Official - Last Name:KORA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-573-5523
Mailing Address - Street 1:33241 FALCON DR
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94555-1128
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:33241 FALCON DR
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94555-1128
Practice Address - Country:US
Practice Address - Phone:510-573-5523
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-21
Last Update Date:2013-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health