Provider Demographics
NPI:1013531920
Name:SG HOMECARE, INC
Entity Type:Organization
Organization Name:SG HOMECARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
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:949-474-2050
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:949-474-2050
Mailing Address - Fax:949-474-4460
Practice Address - Street 1:5550 SKYLANE BLVD STE G
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-1072
Practice Address - Country:US
Practice Address - Phone:707-502-3203
Practice Address - Fax:707-540-6019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-05
Last Update Date:2020-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies