Healthcare Provider Details

I. General information

NPI: 1184294787
Provider Name (Legal Business Name): HOME HEALTH OF ST. CAMILLUS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2021
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5201 DEER VALLEY RD STE 1C
ANTIOCH CA
94531-7430
US

IV. Provider business mailing address

5201 DEER VALLEY RD STE 1C
ANTIOCH CA
94531-7430
US

V. Phone/Fax

Practice location:
  • Phone: 925-978-4118
  • Fax: 925-978-4149
Mailing address:
  • Phone: 925-978-4118
  • Fax: 925-978-4149

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MA ELENA ROBERTS
Title or Position: OWNER
Credential:
Phone: 925-270-5977