Provider Demographics
NPI:1982063764
Name:ST. JOSEPH HEALTH SYSTEM HOME CARE SERVICES
Entity Type:Organization
Organization Name:ST. JOSEPH HEALTH SYSTEM HOME CARE SERVICES
Other - Org Name:SEA CREST HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF ADMINISTRATIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-449-4942
Mailing Address - Street 1:2755 BRISTOL ST
Mailing Address - Street 2:STE. 285
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-5985
Mailing Address - Country:US
Mailing Address - Phone:714-975-8026
Mailing Address - Fax:
Practice Address - Street 1:2755 BRISTOL ST
Practice Address - Street 2:STE. 285
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-5985
Practice Address - Country:US
Practice Address - Phone:714-975-8026
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-22
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA551658Medicare Oscar/Certification