Provider Demographics
NPI:1457464703
Name:1 ST PROVIDENCE HOME HEALTH CARE INC
Entity Type:Organization
Organization Name:1 ST PROVIDENCE HOME HEALTH CARE INC
Other - Org Name:A PLUS HOME HEALTH CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:BARNACASTLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-323-5510
Mailing Address - Street 1:1900 E TAHQUITZ CANYON WAY
Mailing Address - Street 2:#B-4
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-7061
Mailing Address - Country:US
Mailing Address - Phone:760-323-5510
Mailing Address - Fax:760-323-2097
Practice Address - Street 1:1900 E TAHQUITZ CANYON WAY
Practice Address - Street 2:#B-4
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-7061
Practice Address - Country:US
Practice Address - Phone:760-323-5510
Practice Address - Fax:760-323-2097
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2015-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20005681251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHHA08331FMedicaid
CA058331Medicare Oscar/Certification