Provider Demographics
NPI:1184294787
Name:HOME HEALTH OF ST. CAMILLUS LLC
Entity type:Organization
Organization Name:HOME HEALTH OF ST. CAMILLUS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MA ELENA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-270-5977
Mailing Address - Street 1:50 SAND CREEK RD STE 236
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:94513-7302
Mailing Address - Country:US
Mailing Address - Phone:925-270-5977
Mailing Address - Fax:
Practice Address - Street 1:50 SAND CREEK RD STE 236
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:CA
Practice Address - Zip Code:94513-7302
Practice Address - Country:US
Practice Address - Phone:925-270-5977
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-28
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health