=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205582442
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TRUE CARE HOME HEALTH OF NORTHERN CALIFORNIA, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/25/2022
-----------------------------------------------------
Last Update Date | 02/25/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6375 AUBURN BLVD STE 300
-----------------------------------------------------
City | CITRUS HEIGHTS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95621-5203
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-720-2770
-----------------------------------------------------
Fax | 916-542-2270
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7355 TOPANGA CANYON BLVD
-----------------------------------------------------
City | CANOGA PARK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91303-1244
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-762-7171
-----------------------------------------------------
Fax | 818-762-7117
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MIKE FAYFEL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 310-770-5284
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------