MEDICARE: ST. JOSEPH HEALTH SYSTEM HOME CARE SERVICES LLC

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	3336C0004X	Compounding Pharmacy
2	333600000X	Pharmacy

General Provider Information

NPI Number	:	1518569219
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST. JOSEPH HEALTH SYSTEM HOME CARE SERVICES LLC

Provider Business Mailing Address
First Line	:	2703 N ONTARIO ST STE 120&130
Second Line	:
City	:	BURBANK
State	:	CA
Zip	:	91504-2508
Country	:	US
Telephone Number	:	818-847-6558
Fax Number	:

Provider Business Practice Location Address
First Line	:	2703 N ONTARIO ST STE 120&130
Second Line	:
City	:	BURBANK
State	:	CA
Zip	:	91504-2508
Country	:	US
Telephone Number	:	818-847-6558
Fax Number	:

Authorized Official
Title or Position	:	ASSISTANT SECRETARY FOR ENROLLMENT
Name	:	DONALD WAYNE ANDERSON JR.
Credential	:
Telephone Number	:	425-358-9786

Provider Enumeration Date	:	11/09/2020
Last Update Date	:	12/18/2025

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