Healthcare Provider Details

I. General information

NPI: 1053193680
Provider Name (Legal Business Name): SAN GIORGIO HOME HEALTH CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2023
Last Update Date: 10/18/2023
Certification Date: 10/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11712 MOORPARK ST STE 11B
STUDIO CITY CA
91604-2154
US

IV. Provider business mailing address

11712 MOORPARK ST STE 11B
STUDIO CITY CA
91604-2154
US

V. Phone/Fax

Practice location:
  • Phone: 323-410-6427
  • Fax: 323-410-6447
Mailing address:
  • Phone: 323-410-6427
  • Fax: 323-410-6447

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: ART CROSSMAN
Title or Position: CEO
Credential:
Phone: 323-410-6427