Provider Demographics
NPI:1881875367
Name:ST. LUKE'S HOME HEALTH SERVICES, INC.
Entity type:Organization
Organization Name:ST. LUKE'S HOME HEALTH SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANCIS
Authorized Official - Middle Name:
Authorized Official - Last Name:MANGURAMAS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:714-484-4628
Mailing Address - Street 1:5721 LINCOLN AVE
Mailing Address - Street 2:UNIT P
Mailing Address - City:CYPRESS
Mailing Address - State:CA
Mailing Address - Zip Code:90630-3300
Mailing Address - Country:US
Mailing Address - Phone:714-484-4628
Mailing Address - Fax:714-484-0965
Practice Address - Street 1:5721 LINCOLN AVE
Practice Address - Street 2:UNIT P
Practice Address - City:CYPRESS
Practice Address - State:CA
Practice Address - Zip Code:90630-3300
Practice Address - Country:US
Practice Address - Phone:714-484-4628
Practice Address - Fax:714-484-0965
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-26
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHHA08385FMedicaid
CAHHA08385FMedicaid