Provider Demographics
NPI:1396782751
Name:ST. GEORGE HEALTH CARE, INC.
Entity type:Organization
Organization Name:ST. GEORGE HEALTH CARE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/DPCS
Authorized Official - Prefix:MRS
Authorized Official - First Name:GEORGIA
Authorized Official - Middle Name:ARCE
Authorized Official - Last Name:FUNESTO
Authorized Official - Suffix:
Authorized Official - Credentials:BSN RN
Authorized Official - Phone:510-795-1632
Mailing Address - Street 1:5600 MOWRY SCHOOL RD
Mailing Address - Street 2:STE 250
Mailing Address - City:NEWARK
Mailing Address - State:CA
Mailing Address - Zip Code:94560-5806
Mailing Address - Country:US
Mailing Address - Phone:510-795-1632
Mailing Address - Fax:510-795-1301
Practice Address - Street 1:5600 MOWRY SCHOOL RD
Practice Address - Street 2:STE 250
Practice Address - City:NEWARK
Practice Address - State:CA
Practice Address - Zip Code:94560-5806
Practice Address - Country:US
Practice Address - Phone:510-795-1632
Practice Address - Fax:510-795-1301
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST. GEORGE HEALTH CARE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-02
Last Update Date:2012-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA058479Medicare Oscar/Certification