MEDICARE: ON MY OWN INDEPENDENT LIVING SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251C00000X	Developmentally Disabled Services Day Training Agency	0000014653	CA
2	253Z00000X	In Home Supportive Care Agency	0000014653	CA

General Provider Information

NPI Number	:	1225298144
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ON MY OWN INDEPENDENT LIVING SERVICES

Provider Business Mailing Address
First Line	:	6060 SUNRISE VISTA DR STE 2100
Second Line	:
City	:	CITRUS HEIGHTS
State	:	CA
Zip	:	95610-7068
Country	:	US
Telephone Number	:	916-726-0792
Fax Number	:

Provider Business Practice Location Address
First Line	:	6060 SUNRISE VISTA DR STE 2140
Second Line	:
City	:	CITRUS HEIGHTS
State	:	CA
Zip	:	95610-7057
Country	:	US
Telephone Number	:	916-726-0792
Fax Number	:

Authorized Official
Title or Position	:	EXECTUIVE DIRECTOR
Name	:	MRS. MICHELLE RAMIREZ
Credential	:	MA
Telephone Number	:	916-726-0792

Provider Enumeration Date	:	06/13/2008
Last Update Date	:	06/28/2011

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