MEDICARE: SENIOR HOME CARE SPECIALISTS 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	:	1922755081
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SENIOR HOME CARE SPECIALISTS LLC

Provider Business Mailing Address
First Line	:	3322 SWEETWATER SPRINGS BLVD STE 205
Second Line	:
City	:	SPRING VALLEY
State	:	CA
Zip	:	91977-3142
Country	:	US
Telephone Number	:	619-393-4938
Fax Number	:

Provider Business Practice Location Address
First Line	:	3322 SWEETWATER SPRINGS BLVD STE 205
Second Line	:
City	:	SPRING VALLEY
State	:	CA
Zip	:	91977-3142
Country	:	US
Telephone Number	:	619-393-4938
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. PHILIP CAPUA
Credential	:	PHYSICAL THERAPIST
Telephone Number	:	619-942-3656

Provider Enumeration Date	:	03/08/2022
Last Update Date	:	03/08/2022

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