Healthcare Provider Details

I. General information

NPI: 1104640689
Provider Name (Legal Business Name): YOUR CHOICE HOME HEALTH CARE AGENCY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2024
Last Update Date: 11/12/2024
Certification Date: 11/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9730 WILSHIRE BLVD STE 207
BEVERLY HILLS CA
90212-2004
US

IV. Provider business mailing address

3185 WILSHIRE BLVD UNIT 783
LOS ANGELES CA
90010-1253
US

V. Phone/Fax

Practice location:
  • Phone: 310-634-4508
  • Fax:
Mailing address:
  • Phone: 310-634-4508
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number State

VIII. Authorized Official

Name: RUTH BALAROSAN
Title or Position: DIRECTOR
Credential: LVN
Phone: 310-634-4508