=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699665331
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EUCALYPTUS HOME CARE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/04/2025
-----------------------------------------------------
Last Update Date | 07/04/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 16950 VIA DE SANTA FE STE 132
-----------------------------------------------------
City | RANCHO SANTA FE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92067-9600
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 858-900-3050
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 16950 VIA DE SANTA FE STE 132
-----------------------------------------------------
City | RANCHO SANTA FE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92067-9600
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 858-900-3050
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. JIM DICKSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 858-472-5912
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------