Provider Demographics
NPI:1053392308
Name:O'CONNOR HOSPITAL HOME HEALTH CARE AGENCY
Entity type:Organization
Organization Name:O'CONNOR HOSPITAL HOME HEALTH CARE AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MS
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:BARTON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:408-947-2724
Mailing Address - Street 1:2105 FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-1425
Mailing Address - Country:US
Mailing Address - Phone:408-947-2724
Mailing Address - Fax:408-947-3431
Practice Address - Street 1:2030 FOREST AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-4833
Practice Address - Country:US
Practice Address - Phone:408-947-2724
Practice Address - Fax:408-947-3431
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZR07201HMedicaid
CAZZR07201HMedicaid
CA=========OtherTAX IDENTIFICATION NUMBER