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General NPI Number Information
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NPI Number | 1730162579
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Entity Type | Organization
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Legal Business Name | ST JOSEPH HEALTH SYSTEM HOME HEALTH AGENCY LLC
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Dates
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Enumeration Date | 11/25/2005
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Last Update Date | 05/16/2025
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Provider Practice Location Address
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Address Line | 200 W CENTER STREET PROMENADE STE 200C
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City | ANAHEIM
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State | CA
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Zip | 92805-3960
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Country | US
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Telephone | 714-712-9500
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Fax |
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Provider Business Mailing Address
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Address Line | P.O. BOX 31001-1956 COMMERCIAL PAY LOCKBOX
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City | PASADENA
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State | CA
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Zip | 91110-1956
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Country | US
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Telephone | 714-712-9500
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Fax | 714-712-7157
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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 | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 060000277
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License Number State | CA
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