1396832952 NPI number — INFINITE HOME HEALTH, INC.

Table of content: KYLIE JORDAN HARTE MD (NPI 1285253260)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396832952 NPI number — INFINITE HOME HEALTH, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INFINITE 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:
1396832952
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/12/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
875 S WESTLAKE BLVD
Provider Second Line Business Mailing Address:
SUITE # 205
Provider Business Mailing Address City Name:
WESTLAKE VILLAGE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91361-2902
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-497-1777
Provider Business Mailing Address Fax Number:
805-497-7771

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
875 S WESTLAKE BLVD
Provider Second Line Business Practice Location Address:
SUITE # 205
Provider Business Practice Location Address City Name:
WESTLAKE VILLAGE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91361-2902
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-497-1777
Provider Business Practice Location Address Fax Number:
805-497-7771
Provider Enumeration Date:
10/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BIDARI
Authorized Official First Name:
TAIMOOR
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO CFO
Authorized Official Telephone Number:
805-497-1777

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  050000594 , 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: HHA08300F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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