Healthcare Provider Details

I. General information

NPI: 1801981634
Provider Name (Legal Business Name): ST. JOSEPH HOME CARE NETWORK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 05/16/2025
Certification Date: 05/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

441 COLLEGE AVE
SANTA ROSA CA
95401-5141
US

IV. Provider business mailing address

PO BOX 31001-1986
PASADENA CA
91110-1986
US

V. Phone/Fax

Practice location:
  • Phone: 707-206-9124
  • Fax: 707-206-9420
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number010000281
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number010000281
License Number StateCA

VIII. Authorized Official

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