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General NPI Number Information
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NPI Number | 1457772675
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Entity Type | Organization
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Legal Business Name | ST. JOSEPH HEALTH SYSTEM HOME CARE SERVICES LLC
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Dates
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Enumeration Date | 12/16/2013
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Last Update Date | 05/16/2025
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Provider Practice Location Address
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Address Line | 8560 VINEYARD AVE STE 516
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-4350
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Country | US
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Telephone | 909-728-2801
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Fax | 909-292-4512
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Provider Business Mailing Address
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Address Line | 8560 VINEYARD AVE STE 516
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-4350
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Country | US
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Telephone | 909-728-2801
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Fax | 909-292-4512
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Authorized Official
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Title or Position | ASSISTANT SECRETARY FOR ENROLLMENT
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Name | DONALD WAYNE ANDERSON JR.
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Credential |
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Telephone | 425-358-9786
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251G00000X
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Taxonomy Name | Community Based Hospice Care Agency
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License Number |
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License Number State |
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