Healthcare Provider Details

I. General information

NPI: 1487153664
Provider Name (Legal Business Name): ROXAN FAMILY HOME CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2018
Last Update Date: 02/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 ACCOLADE DR
SAN LEANDRO CA
94577-1591
US

IV. Provider business mailing address

1319 WASHINGTON AVE PO BOX 855
SAN LEANDRO CA
94577
US

V. Phone/Fax

Practice location:
  • Phone: 877-887-7022
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number014700064
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number014700064
License Number StateCA

VIII. Authorized Official

Name: MR. VICTOR APARICIO
Title or Position: PRESIDENT
Credential:
Phone: 877-887-7022