Healthcare Provider Details

I. General information

NPI: 1396418737
Provider Name (Legal Business Name): SG HOMECARE,INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2021
Last Update Date: 10/15/2025
Certification Date: 10/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

642 S WATERMAN AVE
SAN BERNARDINO CA
92408-2330
US

IV. Provider business mailing address

345 MCCORMICK AVE
COSTA MESA CA
92626-3422
US

V. Phone/Fax

Practice location:
  • Phone: 909-435-2345
  • Fax: 800-429-6403
Mailing address:
  • Phone: 949-474-2050
  • Fax: 949-474-4460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: JAY CHARLES WENDT
Title or Position: CEO
Credential:
Phone: 949-474-2050