Provider Demographics
NPI:1750531372
Name:SAN DIEGO HOME HEALTH CARE SERVICES, INC.
Entity type:Organization
Organization Name:SAN DIEGO HOME HEALTH CARE SERVICES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER, SEC./TREAS.
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:VINCENT
Authorized Official - Last Name:O'SULLIVAN
Authorized Official - Suffix:JR
Authorized Official - Credentials:PT
Authorized Official - Phone:209-524-8700
Mailing Address - Street 1:3340 TULLY RD
Mailing Address - Street 2:SUITE C-8A
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-0838
Mailing Address - Country:US
Mailing Address - Phone:209-524-8700
Mailing Address - Fax:209-524-8701
Practice Address - Street 1:511 ENCINITAS BOULEVARD
Practice Address - Street 2:SUITE 100
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-3778
Practice Address - Country:US
Practice Address - Phone:760-436-7344
Practice Address - Fax:760-436-4346
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-19
Last Update Date:2013-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X
CA550001041251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA05-9111Medicare UPIN