Provider Demographics
NPI:1306344353
Name:SADDLEBACK HOME HEALTH SERVICES, INC.
Entity type:Organization
Organization Name:SADDLEBACK HOME HEALTH SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MIA JOSEFA
Authorized Official - Middle Name:
Authorized Official - Last Name:JUANEZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-628-6404
Mailing Address - Street 1:325 GENOA ST UNIT C
Mailing Address - Street 2:
Mailing Address - City:MONROVIA
Mailing Address - State:CA
Mailing Address - Zip Code:91016-4505
Mailing Address - Country:US
Mailing Address - Phone:424-202-1704
Mailing Address - Fax:
Practice Address - Street 1:502 W ROUTE 66 STE 26
Practice Address - Street 2:
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91740-4382
Practice Address - Country:US
Practice Address - Phone:626-628-6404
Practice Address - Fax:626-628-3424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-24
Last Update Date:2018-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA01Medicaid