Provider Demographics
NPI:1720808090
Name:FULL CARE HOMEHEALTH, INC
Entity type:Organization
Organization Name:FULL CARE HOMEHEALTH, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR DESIGNEE
Authorized Official - Prefix:
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROUSH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-371-9072
Mailing Address - Street 1:223 E THOUSAND OAKS BLVD
Mailing Address - Street 2:SUITE 320 - 2
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360
Mailing Address - Country:US
Mailing Address - Phone:805-371-9072
Mailing Address - Fax:805-371-9074
Practice Address - Street 1:223 E THOUSAND OAKS BLVD
Practice Address - Street 2:SUITE 320 - 2
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360
Practice Address - Country:US
Practice Address - Phone:805-371-9072
Practice Address - Fax:805-371-9074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-11
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health