1700042397 NPI number — EASTWEST HOMECARE ORANGE INC

Table of content: (NPI 1700042397)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700042397 NPI number — EASTWEST HOMECARE ORANGE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EASTWEST HOMECARE ORANGE 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:
INTERIM HEALTHCARE ORANGE
Provider Other Organization Name Type Code:
3
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:
1700042397
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/25/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16429 BERWYN RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CERRITOS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90703-2440
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
562-207-6970
Provider Business Mailing Address Fax Number:
562-207-6981

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
23691 BIRTCHER DR
Provider Second Line Business Practice Location Address:
A
Provider Business Practice Location Address City Name:
LAKE FOREST
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92630-1770
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-334-5770
Provider Business Practice Location Address Fax Number:
949-334-5777
Provider Enumeration Date:
08/02/2008

Additional Information

Authorized Official

Authorized Official Last Name:
CHANG
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
714-709-3417

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  980000254 , 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: HHA07850F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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