Healthcare Provider Details

I. General information

NPI: 1386223428
Provider Name (Legal Business Name): HOAG AT HOME LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2021
Last Update Date: 04/06/2021
Certification Date: 04/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4041 MACARTHUR BLVD STE 400
NEWPORT BEACH CA
92660-2554
US

IV. Provider business mailing address

4041 MACARTHUR BLVD STE 400
NEWPORT BEACH CA
92660-2554
US

V. Phone/Fax

Practice location:
  • Phone: 949-736-6100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: ROBERT DECKER
Title or Position: DORECTOR
Credential: PT
Phone: 949-463-1510