Provider Demographics
NPI:1770002347
Name:SG HOMECARE, INC.
Entity type:Organization
Organization Name:SG HOMECARE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CLIENT SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDRIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HREN
Authorized Official - Suffix:
Authorized Official - Credentials:LVN
Authorized Official - Phone:949-474-2050
Mailing Address - Street 1:15602 MOSHER AVE
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-6427
Mailing Address - Country:US
Mailing Address - Phone:949-474-2050
Mailing Address - Fax:
Practice Address - Street 1:31385 PLANTATION DR
Practice Address - Street 2:
Practice Address - City:THOUSAND PALMS
Practice Address - State:CA
Practice Address - Zip Code:92276-6602
Practice Address - Country:US
Practice Address - Phone:949-474-3050
Practice Address - Fax:949-474-4460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-15
Last Update Date:2025-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA11747494972Medicaid