MEDICARE: 8262EMH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency	VN136932	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1649648163
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	8262EMH

Provider Business Mailing Address
First Line	:	3713 E ARABELLA ST
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90805-3915
Country	:	US
Telephone Number	:	562-786-4994
Fax Number	:

Provider Business Practice Location Address
First Line	:	3713 E ARABELLA ST
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90805-3915
Country	:	US
Telephone Number	:	562-786-4994
Fax Number	:

Authorized Official
Title or Position	:	PRIVATE NURSE
Name	:	ETHEL MARIE HAWKINS
Credential	:
Telephone Number	:	562-786-4994

Provider Enumeration Date	:	09/15/2015
Last Update Date	:	09/15/2015

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