MEDICARE: ST. JOSEPH HEALTH SYSTEM HOME CARE 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
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1396103354
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST. JOSEPH HEALTH SYSTEM HOME CARE SERVICES

Provider Business Mailing Address
First Line	:	3187 RED HILL AVE.
Second Line	:	STE 200
City	:	COSTA MESA
State	:	CA
Zip	:	92626
Country	:	US
Telephone Number	:	149-758-0117
Fax Number	:

Provider Business Practice Location Address
First Line	:	3187 RED HILL AVE
Second Line	:	STE 200
City	:	COSTA MESA
State	:	CA
Zip	:	92626
Country	:	US
Telephone Number	:	714-975-8011
Fax Number	:

Authorized Official
Title or Position	:	SERVICE AREA CFO
Name	:	LYDIA THANGAIYAN
Credential	:
Telephone Number	:	714-712-7130

Provider Enumeration Date	:	02/05/2016
Last Update Date	:	04/28/2020

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