Provider Demographics
NPI:1861719577
Name:PRESIDIO HOME CARE LLC
Entity type:Organization
Organization Name:PRESIDIO HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / OPERATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:COLIN
Authorized Official - Middle Name:M
Authorized Official - Last Name:BARNES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-304-0442
Mailing Address - Street 1:936 E GREEN ST
Mailing Address - Street 2:SUITE #105
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91106-2900
Mailing Address - Country:US
Mailing Address - Phone:800-567-4117
Mailing Address - Fax:877-637-7309
Practice Address - Street 1:936 E GREEN ST
Practice Address - Street 2:SUITE #105
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91106-2900
Practice Address - Country:US
Practice Address - Phone:800-567-4117
Practice Address - Fax:877-637-7309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-21
Last Update Date:2010-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care