Healthcare Provider Details

I. General information

NPI: 1932912334
Provider Name (Legal Business Name): STACEY'S HOME HEALTH INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2025
Last Update Date: 10/06/2025
Certification Date: 10/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30700 RUSSELL RANCH RD STE 250
WESTLAKE VILLAGE CA
91362-9507
US

IV. Provider business mailing address

30700 RUSSELL RANCH RD STE 250
WESTLAKE VILLAGE CA
91362-9507
US

V. Phone/Fax

Practice location:
  • Phone: 805-638-2918
  • Fax:
Mailing address:
  • Phone: 805-638-2918
  • Fax: 805-855-4148

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: STACEY SCHULTHEIS
Title or Position: CEO
Credential: RN
Phone: 805-638-2918