Provider Demographics
NPI:1366978066
Name:LAKE FOREST HOME CARE, INC.
Entity type:Organization
Organization Name:LAKE FOREST HOME CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARILOU
Authorized Official - Middle Name:
Authorized Official - Last Name:GALAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-892-8508
Mailing Address - Street 1:22762 ASPAN ST
Mailing Address - Street 2:SUITE # 206
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-1604
Mailing Address - Country:US
Mailing Address - Phone:949-305-2431
Mailing Address - Fax:949-206-9261
Practice Address - Street 1:22762 ASPAN ST
Practice Address - Street 2:SUITE # 206
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-1604
Practice Address - Country:US
Practice Address - Phone:949-305-2431
Practice Address - Fax:949-206-9261
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-02
Last Update Date:2017-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA304700068253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care