Provider Demographics
NPI:1134388747
Name:ST MARYS HEALTHCARE CORP.
Entity type:Organization
Organization Name:ST MARYS HEALTHCARE CORP.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DARYL
Authorized Official - Middle Name:E
Authorized Official - Last Name:VELASCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-244-5448
Mailing Address - Street 1:1525 MCCARTHY BLVD STE 208
Mailing Address - Street 2:
Mailing Address - City:MILPITAS
Mailing Address - State:CA
Mailing Address - Zip Code:95035-7452
Mailing Address - Country:US
Mailing Address - Phone:408-244-4488
Mailing Address - Fax:408-321-7419
Practice Address - Street 1:1525 MCCARTHY BLVD STE 208
Practice Address - Street 2:
Practice Address - City:MILPITAS
Practice Address - State:CA
Practice Address - Zip Code:95035-7452
Practice Address - Country:US
Practice Address - Phone:408-244-4488
Practice Address - Fax:408-321-7419
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-09
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA059009Medicare PIN