Provider Demographics
NPI:1982602496
Name:LOS ROBLES HOMECARE SERVICES INC
Entity Type:Organization
Organization Name:LOS ROBLES HOMECARE SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BURNINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-845-3213
Mailing Address - Street 1:68 LONG CT
Mailing Address - Street 2:SUITE 2C
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-6060
Mailing Address - Country:US
Mailing Address - Phone:805-777-7234
Mailing Address - Fax:805-777-0101
Practice Address - Street 1:68 LONG CT
Practice Address - Street 2:SUITE 2C
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-6060
Practice Address - Country:US
Practice Address - Phone:805-777-7234
Practice Address - Fax:805-777-0101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-08
Last Update Date:2020-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA050000552251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA=========OtherTAX ID NUMBER
CA=========OtherTAX ID NUMBER