Provider Demographics
NPI:1457107153
Name:ST. PEREGRINE HOME HEALTH & PALLIATIVE CARE LLC
Entity Type:Organization
Organization Name:ST. PEREGRINE HOME HEALTH & PALLIATIVE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:FLORANTE
Authorized Official - Middle Name:S
Authorized Official - Last Name:BALTAZAR
Authorized Official - Suffix:III
Authorized Official - Credentials:LVN
Authorized Official - Phone:949-664-1564
Mailing Address - Street 1:5612 N FRESNO ST STE 109
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-6182
Mailing Address - Country:US
Mailing Address - Phone:949-664-1564
Mailing Address - Fax:
Practice Address - Street 1:5612 N FRESNO ST STE 109
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-6182
Practice Address - Country:US
Practice Address - Phone:949-664-1564
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-24
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health