1225090863 NPI number — GREATER SOUTH BAY AREA HOME HEALTH, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225090863 NPI number — GREATER SOUTH BAY AREA HOME HEALTH, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GREATER SOUTH BAY AREA HOME HEALTH, 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:
1225090863
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:
680 KNOX STREET
Provider Second Line Business Mailing Address:
SUITE 125
Provider Business Mailing Address City Name:
TORRANCE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90502-1342
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-329-4835
Provider Business Mailing Address Fax Number:
310-329-4894

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
680 KNOX ST
Provider Second Line Business Practice Location Address:
SUITE 125
Provider Business Practice Location Address City Name:
TORRANCE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90502-1305
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-329-4835
Provider Business Practice Location Address Fax Number:
310-329-4894
Provider Enumeration Date:
04/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RAMOS
Authorized Official First Name:
LILIA
Authorized Official Middle Name:
CRISOSTOMO
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
310-329-4835

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: HHA57476F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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