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General NPI Number Information
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NPI Number | 1588515662
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Entity Type | Organization
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Legal Business Name | MY BROTHER'S HOUSE
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Dates
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Enumeration Date | 02/05/2026
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Last Update Date | 02/05/2026
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Provider Practice Location Address
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Address Line | 8501 OAKCREEK COVE WAY
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City | ORANGEVALE
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State | CA
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Zip | 95662-6003
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Country | US
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Telephone | 916-812-8955
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Fax | 916-812-8955
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Provider Business Mailing Address
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Address Line | 8501 OAKCREEK COVE WAY
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City | ORANGEVALE
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State | CA
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Zip | 95662-6003
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Country | US
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Telephone | 916-812-8955
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Fax | 916-812-8955
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MARY MATA
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Credential | RN MSA BSN
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Telephone | 916-812-8055
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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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