Healthcare Provider Details

I. General information

NPI: 1144474446
Provider Name (Legal Business Name): LAX HOME HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2008
Last Update Date: 11/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8109 2ND ST STE 3
DOWNEY CA
90241-3623
US

IV. Provider business mailing address

8109 2ND STREET SUITE#3
DOWNEY CA
90241
US

V. Phone/Fax

Practice location:
  • Phone: 562-923-3990
  • Fax: 562-923-2440
Mailing address:
  • Phone: 562-923-3990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number980000736
License Number StateCA

VIII. Authorized Official

Name: MRS. MYRIAN MELNECHUK
Title or Position: ADMINISTRATOR, CEO
Credential: OT
Phone: 562-923-3990