Provider Demographics
NPI:1396103354
Name:ST. JOSEPH HEALTH SYSTEM HOME CARE SERVICES
Entity type:Organization
Organization Name:ST. JOSEPH HEALTH SYSTEM HOME CARE SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SERVICE AREA CFO
Authorized Official - Prefix:
Authorized Official - First Name:LYDIA
Authorized Official - Middle Name:
Authorized Official - Last Name:THANGAIYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-712-7130
Mailing Address - Street 1:3187 RED HILL AVE.
Mailing Address - Street 2:STE 200
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626
Mailing Address - Country:US
Mailing Address - Phone:149-758-0117
Mailing Address - Fax:
Practice Address - Street 1:3187 RED HILL AVE
Practice Address - Street 2:STE 200
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626
Practice Address - Country:US
Practice Address - Phone:714-975-8011
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-05
Last Update Date:2020-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA058238Medicare Oscar/Certification