Provider Demographics
NPI:1013702364
Name:PHOENIX HOME HEALTH SACRAMENTO LLC
Entity type:Organization
Organization Name:PHOENIX HOME HEALTH SACRAMENTO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-731-7173
Mailing Address - Street 1:5447 COCHISE ST
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93063-2049
Mailing Address - Country:US
Mailing Address - Phone:818-731-7173
Mailing Address - Fax:
Practice Address - Street 1:2255 WATT AVE STE 320-D
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-0508
Practice Address - Country:US
Practice Address - Phone:805-298-0012
Practice Address - Fax:626-683-9969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-09
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health