Provider Demographics
NPI:1174749972
Name:SG HOMECARE, INC
Entity type:Organization
Organization Name:SG HOMECARE, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALEXANDRIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HREN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-474-2050
Mailing Address - Street 1:15602 MOSHER AVE
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-6427
Mailing Address - Country:US
Mailing Address - Phone:949-355-3675
Mailing Address - Fax:
Practice Address - Street 1:15602 MOSHER AVE
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-6427
Practice Address - Country:US
Practice Address - Phone:949-474-2050
Practice Address - Fax:949-474-4460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2025-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1174749972Medicaid
CA4401720002Medicare NSC