MEDICARE: PASSIONATE CARE AT HOME INC.

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	:	1700128642
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PASSIONATE CARE AT HOME INC.

Provider Business Mailing Address
First Line	:	2412 CARTA CT
Second Line	:	SUITE 2
City	:	SACRAMENTO
State	:	CA
Zip	:	95825-4470
Country	:	US
Telephone Number	:	866-457-0570
Fax Number	:

Provider Business Practice Location Address
First Line	:	2412 CARTA CT
Second Line	:	SUITE 2
City	:	SACRAMENTO
State	:	CA
Zip	:	95825-4470
Country	:	US
Telephone Number	:	866-457-0570
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATIVE DIRECTOR
Name	:	M MENDOZA
Credential	:
Telephone Number	:	866-457-0570

Provider Enumeration Date	:	03/18/2013
Last Update Date	:	05/02/2013

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