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General NPI Number Information
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NPI Number | 1962714758
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Entity Type | Organization
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Legal Business Name | HOME CARE BY THE SEA
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Dates
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Enumeration Date | 07/08/2010
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Last Update Date | 11/18/2014
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Provider Practice Location Address
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Address Line | 625 MIRAMONTES ST STE 203
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City | HALF MOON BAY
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State | CA
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Zip | 94019-1942
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Country | US
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Telephone | 650-560-9844
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Fax | 650-560-9642
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Provider Business Mailing Address
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Address Line | PO BOX 3680
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City | HALF MOON BAY
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State | CA
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Zip | 94019-3680
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Country | US
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Telephone | 650-560-9844
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Fax | 650-560-9642
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. MICHAEL DOUGLAS EUGENE COBB
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Credential |
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Telephone | 650-560-9844
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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 | 550001410
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License Number State | CA
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