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NPI Code Detail

MEDICARE: ON MY OWN INDEPENDENT LIVING SERVICES

MEDICARE: ON MY OWN INDEPENDENT LIVING SERVICES
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
1251C00000XDevelopmentally Disabled Services Day Training Agency
2251G00000XCommunity Based Hospice Care Agency
3251J00000XNursing Care Agency
4253Z00000XIn Home Supportive Care AgencyCA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12407772OTHERCACOMPANY CORPORATION NUMBER
2347004697OTHERCARCFE CARE HOME LICENSE
3GEN-05336OTHERCACALIFORNIA BUSINESS LICENSE

General Provider Information

NPI Number : 1346792488
Entity Type Code : Organization
Provider Name (Legal Business Name) : ON MY OWN INDEPENDENT LIVING SERVICES
Provider Business Mailing Address
First Line : 6939 SUNRISE BLVD
Second Line : SUITE 215
City : CITRUS HEIGHTS
State : CA
Zip : 95610-3153
Country : US
Telephone Number : 916-726-0792
Fax Number :
Provider Business Practice Location Address
First Line : 6939 SUNRISE BLVD
Second Line : SUITE 215
City : CITRUS HEIGHTS
State : CA
Zip : 95610-3153
Country : US
Telephone Number : 916-726-0792
Fax Number :
Authorized Official
Title or Position : CEO
Name : MICHELLE RAMIREZ
Credential :
Telephone Number : 916-726-0792
Provider Enumeration Date : 10/25/2016
Last Update Date : 10/25/2016

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Directions to “ON MY OWN INDEPENDENT LIVING SERVICES ” Practice Location

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