Healthcare Provider Details

I. General information

NPI: 1174992598
Provider Name (Legal Business Name): CARSON HEALTHCARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2015
Last Update Date: 09/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17625 CENTRAL AVE
CARSON CA
90746-1661
US

IV. Provider business mailing address

17625 CENTRAL AVE
CARSON CA
90746-1661
US

V. Phone/Fax

Practice location:
  • Phone: 310-228-8682
  • Fax:
Mailing address:
  • Phone: 310-228-8682
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. CHINWEIKE OGBODO
Title or Position: PRESIDENT
Credential: NP
Phone: 310-228-8682