1902007255 NPI number — CAPITAL HOME HEALTH AGENCY, INC.

Table of content: (NPI 1902007255)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902007255 NPI number — CAPITAL HOME HEALTH AGENCY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CAPITAL HOME HEALTH 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:
1902007255
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/30/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2818 LA CIENEGA AVE
Provider Second Line Business Mailing Address:
SUITE 205
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90034-2618
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-253-5384
Provider Business Mailing Address Fax Number:
310-025-3919

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2818 LA CIENEGA AVE
Provider Second Line Business Practice Location Address:
SUITE 205
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90034-2618
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-253-5384
Provider Business Practice Location Address Fax Number:
310-253-9191
Provider Enumeration Date:
05/31/2007

Additional Information

Authorized Official

Authorized Official Last Name:
LOGAN
Authorized Official First Name:
LINDEN
Authorized Official Middle Name:
LELLIS
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
310-253-5384

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  980001281 , 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: HHA08042F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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