MEDICARE: ST. PEREGRINE HOME HEALTH & PALLIATIVE 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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1457107153
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST. PEREGRINE HOME HEALTH & PALLIATIVE CARE LLC

Provider Business Mailing Address
First Line	:	5612 N FRESNO ST STE 109
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93710-6182
Country	:	US
Telephone Number	:	949-664-1564
Fax Number	:

Provider Business Practice Location Address
First Line	:	5612 N FRESNO ST STE 109
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93710-6182
Country	:	US
Telephone Number	:	949-664-1564
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MR. FLORANTE S BALTAZAR III
Credential	:	LVN
Telephone Number	:	949-664-1564

Provider Enumeration Date	:	04/24/2024
Last Update Date	:	04/24/2024

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