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General NPI Number Information
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NPI Number | 1013702364
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Entity Type | Organization
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Legal Business Name | PHOENIX HOME HEALTH SACRAMENTO LLC
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Dates
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Enumeration Date | 04/09/2025
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Last Update Date | 04/09/2025
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Provider Practice Location Address
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Address Line | 2255 WATT AVE STE 320-D
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City | SACRAMENTO
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State | CA
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Zip | 95825-0508
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Country | US
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Telephone | 805-298-0012
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Fax | 626-683-9969
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Provider Business Mailing Address
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Address Line | 5447 COCHISE ST
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City | SIMI VALLEY
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State | CA
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Zip | 93063-2049
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Country | US
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Telephone | 818-731-7173
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | RALPH SANTOS
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Credential |
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Telephone | 818-731-7173
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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