Healthcare Provider Details

I. General information

NPI: 1407535628
Provider Name (Legal Business Name): SG HOMECARE,INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2023
Last Update Date: 11/12/2024
Certification Date: 11/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42075 REMINGTON AVE STE 102
TEMECULA CA
92590-2558
US

IV. Provider business mailing address

15602 MOSHER AVE
TUSTIN CA
92780-6427
US

V. Phone/Fax

Practice location:
  • Phone: 949-474-2050
  • Fax:
Mailing address:
  • Phone: 949-355-3675
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ALEXANDRIA HREN
Title or Position: VP
Credential:
Phone: 949-355-3675