Provider Demographics
NPI:1679064836
Name:CALIFORNIA IN HOME CARE & REGISTRY, INC
Entity type:Organization
Organization Name:CALIFORNIA IN HOME CARE & REGISTRY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:JEHAZIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:AVANCENA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-578-2069
Mailing Address - Street 1:14B MITCHELL BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903
Mailing Address - Country:US
Mailing Address - Phone:415-578-2067
Mailing Address - Fax:415-785-8248
Practice Address - Street 1:14B MITCHELL BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94903
Practice Address - Country:US
Practice Address - Phone:415-578-2067
Practice Address - Fax:415-785-8248
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-23
Last Update Date:2018-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACOSS214700023253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care