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General NPI Number Information
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NPI Number | 1154314201
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Entity Type | Organization
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Legal Business Name | ST. CLARE'S HOME CARE, INC.
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Dates
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Enumeration Date | 08/24/2005
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Last Update Date | 10/10/2012
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Provider Practice Location Address
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Address Line | 12912 BROOKHURST ST SUITE 402
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City | GARDEN GROVE
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State | CA
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Zip | 92840-4835
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Country | US
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Telephone | 714-638-9700
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Fax | 714-638-9000
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Provider Business Mailing Address
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Address Line | 12912 BROOKHURST ST SUITE 402
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City | GARDEN GROVE
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State | CA
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Zip | 92840-4835
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Country | US
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Telephone | 714-638-9700
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Fax | 714-638-9000
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. RONALD MAGABILIN MANUG
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Credential | R.N.
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Telephone | 714-638-9700
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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 | 060000774
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License Number State | CA
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