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General NPI Number Information
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NPI Number | 1417198110
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Entity Type | Organization
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Legal Business Name | ST. ROSE OF LIMA HEALTHCARE PROVIDER, INC.
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Dates
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Enumeration Date | 03/10/2009
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Last Update Date | 09/18/2025
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Provider Practice Location Address
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Address Line | 4901 LAKEVIEW AVE
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City | YORBA LINDA
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State | CA
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Zip | 92886-3473
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Country | US
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Telephone | 714-777-5931
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Fax | 714-695-9882
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Provider Business Mailing Address
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Address Line | 23361 EL TORO RD STE 218A
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City | LAKE FOREST
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State | CA
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Zip | 92630-6921
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Country | US
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Telephone | 714-777-5931
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Fax | 714-695-9882
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Authorized Official
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Title or Position | CEO
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Name | PARIVASH ASNAASHARI
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Credential |
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Telephone | 714-777-5931
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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 | 630011759
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License Number State | CA
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