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General NPI Number Information
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NPI Number | 1831573435
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Entity Type | Organization
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Legal Business Name | STANDARD HOME HEALTH SERVICE
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Dates
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Enumeration Date | 07/13/2015
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Last Update Date | 07/13/2015
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Provider Practice Location Address
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Address Line | 1933 DAVIS ST SUITE 318
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City | SAN LEANDRO
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State | CA
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Zip | 94577-1260
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Country | US
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Telephone | 510-798-4778
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Fax |
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Provider Business Mailing Address
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Address Line | 1933 DAVIS ST STE 318
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City | SAN LEANDRO
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State | CA
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Zip | 94577-1259
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Country | US
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Telephone | 510-798-4778
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Fax |
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Authorized Official
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Title or Position | C.E.O.
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Name | MR. EPHREM YOHANNES
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Credential |
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Telephone | 510-798-4778
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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 | 550002170
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License Number State | CA
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