Provider Demographics
NPI:1114794138
Name:FAMILY CARE HOSPICE & HOME HEALTH, INC.
Entity type:Organization
Organization Name:FAMILY CARE HOSPICE & HOME HEALTH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:WILMER
Authorized Official - Middle Name:A
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-499-1701
Mailing Address - Street 1:1415 E 17TH ST STE 220E
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-8525
Mailing Address - Country:US
Mailing Address - Phone:714-395-8502
Mailing Address - Fax:888-365-4466
Practice Address - Street 1:1415 E 17TH ST STE 220E
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-8525
Practice Address - Country:US
Practice Address - Phone:714-499-1701
Practice Address - Fax:888-365-4466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-11
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No385H00000XRespite Care FacilityRespite Care
No405300000XOther Service ProvidersPrevention Professional
No305R00000XManaged Care OrganizationsPreferred Provider Organization
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332BD1200XSuppliersDurable Medical Equipment & Medical SuppliesDialysis Equipment & Supplies
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No251E00000XAgenciesHome Health
No251G00000XAgenciesHospice Care, Community Based
No252Y00000XAgenciesEarly Intervention Provider Agency
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1225805245Medicaid
CA1558138362Medicaid