1154390342 NPI number — STAT HOME HEALTH CARE, INC.

Table of content: CELINA NGOZI NWAGBO RN (NPI 1750604484)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154390342 NPI number — STAT HOME HEALTH CARE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STAT HOME HEALTH CARE, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154390342
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2105 BEVERLY BLVD
Provider Second Line Business Mailing Address:
STE. 221
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90057-2216
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
213-483-2355
Provider Business Mailing Address Fax Number:
213-353-0831

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2105 BEVERLY BLVD
Provider Second Line Business Practice Location Address:
STE. 221
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90057-2216
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-483-2355
Provider Business Practice Location Address Fax Number:
213-353-0831
Provider Enumeration Date:
03/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SOHAL
Authorized Official First Name:
JUDITH
Authorized Official Middle Name:
RODRIGUEZ
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
213-483-2355

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: HHA07549G , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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