Provider Demographics
NPI:1205988854
Name:OWEN HEALTHCARE, LLC
Entity type:Organization
Organization Name:OWEN HEALTHCARE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:BURNINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-845-3213
Mailing Address - Street 1:1881 W TRAVERSE PKWY STE E#112
Mailing Address - Street 2:
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-6029
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1109 VICENTE STREET
Practice Address - Street 2:SUITE 103
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94116-3082
Practice Address - Country:US
Practice Address - Phone:415-682-2111
Practice Address - Fax:415-682-2112
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:IMPACT HEALTHCARE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-16
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA070000580251G00000X
CA05D0911970291U00000X
CA220000345251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251G00000XAgenciesHospice Care, Community Based
No291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHHA57796FMedicaid
CAHPC01689FMedicaid
CAHHA57796FMedicaid
CA557796Medicare ID - Type UnspecifiedMEDICARE HOMEHEALTH NUMB.