MEDICARE: SOUTH BAY HOME CARE LLC

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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1366240483
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH BAY HOME CARE LLC

Provider Business Mailing Address
First Line	:	2975 BOWERS AVE STE 215
Second Line	:
City	:	SANTA CLARA
State	:	CA
Zip	:	95051-0955
Country	:	US
Telephone Number	:	408-792-6138
Fax Number	:	650-744-0094

Provider Business Practice Location Address
First Line	:	2975 BOWERS AVE STE 215
Second Line	:
City	:	SANTA CLARA
State	:	CA
Zip	:	95051-0955
Country	:	US
Telephone Number	:	408-792-6138
Fax Number	:	650-744-0094

Authorized Official
Title or Position	:	CEO
Name	:	ANASTASIA KHAN
Credential	:
Telephone Number	:	240-760-9848

Provider Enumeration Date	:	03/05/2025
Last Update Date	:	03/06/2026

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Directions to “SOUTH BAY HOME CARE LLC ” Practice Location

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