MEDICARE: 1ST PROVIDENCE HOME HEALTH CARE INCORPORATED

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	20005681	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194903559
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	1ST PROVIDENCE HOME HEALTH CARE INCORPORATED

Provider Business Mailing Address
First Line	:	1900 E TAHQUITZ CANYON WAY
Second Line	:	SUITE B-4
City	:	PALM SPRINGS
State	:	CA
Zip	:	92262-7061
Country	:	US
Telephone Number	:	760-323-5510
Fax Number	:	760-323-2097

Provider Business Practice Location Address
First Line	:	1900 E TAHQUITZ CANYON WAY
Second Line	:	SUITE B-4
City	:	PALM SPRINGS
State	:	CA
Zip	:	92262-7061
Country	:	US
Telephone Number	:	760-323-5510
Fax Number	:	760-323-2097

Authorized Official
Title or Position	:	OWNER
Name	:	MR. SAMUEL KEITH BARNACASTLE
Credential	:
Telephone Number	:	760-323-5510

Provider Enumeration Date	:	02/07/2008
Last Update Date	:	09/15/2010

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