MEDICARE: EGEMO HOME HEALTH SERVICE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency	110810	CA

General Provider Information

NPI Number	:	1154630853
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EGEMO HOME HEALTH SERVICE

Provider Business Mailing Address
First Line	:	1201 SEA CLIFF WAY
Second Line	:
City	:	OCEANSIDE
State	:	CA
Zip	:	92056-2828
Country	:	US
Telephone Number	:	760-754-7093
Fax Number	:	760-754-2053

Provider Business Practice Location Address
First Line	:	1201 SEA CLIFF WAY
Second Line	:
City	:	OCEANSIDE
State	:	CA
Zip	:	92056-2828
Country	:	US
Telephone Number	:	760-754-7093
Fax Number	:	760-754-2053

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. MARTHA JEAN EGEMO
Credential	:	AA MEDICAL MANAGMENT
Telephone Number	:	760-754-7093

Provider Enumeration Date	:	09/28/2010
Last Update Date	:	09/28/2010

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Directions to “EGEMO HOME HEALTH SERVICE ” Practice Location

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