=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801697982
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PASSIONATE CARE HOME LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/24/2025
-----------------------------------------------------
Last Update Date | 03/24/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1312 MEIGS CT
-----------------------------------------------------
City | CHULA VISTA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91913-3529
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 619-345-3844
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1312 MEIGS CT
-----------------------------------------------------
City | CHULA VISTA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91913-3529
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 619-345-3844
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/ ADMINISTRATOR
-----------------------------------------------------
Name | MR. ROGELIO V DIAZ JR.
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 619-769-4545
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------