Provider Demographics
NPI:1205142528
Name:STEWARD HOME HEALTH AGENCY INC
Entity type:Organization
Organization Name:STEWARD HOME HEALTH AGENCY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARINA
Authorized Official - Middle Name:E
Authorized Official - Last Name:PINK
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:818-468-7295
Mailing Address - Street 1:16446 WOODRUFF AVE STE B
Mailing Address - Street 2:
Mailing Address - City:BELLFLOWER
Mailing Address - State:CA
Mailing Address - Zip Code:90706-4975
Mailing Address - Country:US
Mailing Address - Phone:562-869-6723
Mailing Address - Fax:562-869-9468
Practice Address - Street 1:16446 WOODRUFF AVE STE B
Practice Address - Street 2:
Practice Address - City:BELLFLOWER
Practice Address - State:CA
Practice Address - Zip Code:90706-4975
Practice Address - Country:US
Practice Address - Phone:562-869-6723
Practice Address - Fax:562-869-9468
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-24
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA550001708251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1205142528OtherMEDI-CAL PROV#
CA550001708OtherCDPH
CA1205142528OtherMEDI-CAL PROV#