MEDICARE: ANX HOME HEALTHCARE NURSING - SANTA CLARA INC.

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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1285095299
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANX HOME HEALTHCARE NURSING - SANTA CLARA INC.

Provider Business Mailing Address
First Line	:	828 S BASCOM AVE
Second Line	:	STE 240
City	:	SAN JOSE
State	:	CA
Zip	:	95128-2651
Country	:	US
Telephone Number	:	650-271-5721
Fax Number	:	650-991-5178

Provider Business Practice Location Address
First Line	:	455 HICKEY BLVD STE 415
Second Line	:
City	:	DALY CITY
State	:	CA
Zip	:	94015-2630
Country	:	US
Telephone Number	:	650-271-5721
Fax Number	:	650-991-5178

Authorized Official
Title or Position	:	ADMINISTRATOR / PRESIDENT
Name	:	MR. THOMAS ALLANDALE LAGROSAS ROCAS III
Credential	:	RN BSN
Telephone Number	:	650-271-5721

Provider Enumeration Date	:	03/18/2016
Last Update Date	:	03/18/2016

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