=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407247018
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GIRON-ROQUE HEALTHCARE, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/18/2015
-----------------------------------------------------
Last Update Date | 02/18/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9245 LAGUNA SPRINGS DR SUITE 200
-----------------------------------------------------
City | ELK GROVE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95758-7987
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 408-306-2748
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9245 LAGUNA SPRINGS DR SUITE 200
-----------------------------------------------------
City | ELK GROVE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95758-7987
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 408-306-2748
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/CEO
-----------------------------------------------------
Name | FELINA ROQUE
-----------------------------------------------------
Credential | REGISTERED NURSE
-----------------------------------------------------
Telephone | 408-306-2748
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------