=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649597196
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | STRAIGHT ENTERPRISES, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/23/2010
-----------------------------------------------------
Last Update Date | 04/23/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 23591 EL TORO RD SUITE 155
-----------------------------------------------------
City | LAKE FOREST
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92630-4774
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-837-7000
-----------------------------------------------------
Fax | 949-417-2185
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 23591 EL TORO RD SUITE 155
-----------------------------------------------------
City | LAKE FOREST
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92630-4774
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-837-7000
-----------------------------------------------------
Fax | 949-417-2185
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/OWNER
-----------------------------------------------------
Name | MRS. PHYLLIS EVELYN STRAIGHT
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 949-837-7000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------