Provider Demographics
NPI:1811102064
Name:EGEMO HOMEHEALTH SERVICE
Entity type:Organization
Organization Name:EGEMO HOMEHEALTH SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSING ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:J
Authorized Official - Last Name:EGEMO
Authorized Official - Suffix:
Authorized Official - Credentials:CNA
Authorized Official - Phone:760-931-9017
Mailing Address - Street 1:2244 FARADAY AVE. #101
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008
Mailing Address - Country:US
Mailing Address - Phone:760-931-9017
Mailing Address - Fax:760-931-9082
Practice Address - Street 1:4944 SIESTA DR
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92057
Practice Address - Country:US
Practice Address - Phone:760-931-9017
Practice Address - Fax:760-931-9082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1223990251E00000X, 251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered251E00000XAgenciesHome Health
Not Answered251J00000XAgenciesNursing Care