Healthcare Provider Details

I. General information

NPI: 1083697833
Provider Name (Legal Business Name): ST. JOSEPH HEALTH SYSTEM HOME CARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/25/2005
Last Update Date: 05/16/2025
Certification Date: 05/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W. CENTER STREET PROMENADE SUITTE 200
ANAHEIM CA
92805
US

IV. Provider business mailing address

PO BOX 31001-3044 COMMERCIAL PAY LOCKBOX
PASADENA CA
91110-3044
US

V. Phone/Fax

Practice location:
  • Phone: 714-712-9500
  • Fax: 714-712-9520
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State

VIII. Authorized Official

Name: DONALD W ANDERSON JR.
Title or Position: ASSISTANT SECRETARY FOR ENROLLMENT
Credential:
Phone: 425-358-9786