1386647931 NPI number — VICTORIA HOME HEALTH NURSING AGENCY, INC.

Table of content: (NPI 1386647931)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386647931 NPI number — VICTORIA HOME HEALTH NURSING AGENCY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VICTORIA HOME HEALTH NURSING AGENCY, 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:
1386647931
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/13/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8455 BEVERLY BLVD
Provider Second Line Business Mailing Address:
SUITE 302
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90048-3416
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
323-653-3830
Provider Business Mailing Address Fax Number:
323-653-3880

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8455 BEVERLY BLVD
Provider Second Line Business Practice Location Address:
STE 302
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90048-3421
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-653-3830
Provider Business Practice Location Address Fax Number:
323-653-3880
Provider Enumeration Date:
05/27/2005

Additional Information

Authorized Official

Authorized Official Last Name:
INGENTE
Authorized Official First Name:
LUCIA
Authorized Official Middle Name:
BASILIO
Authorized Official Title or Position:
ADMINISTRATOR DON
Authorized Official Telephone Number:
323-653-3830

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: HHA08208F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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