Healthcare Provider Details

I. General information

NPI: 1841694536
Provider Name (Legal Business Name): SOUTH BAY HOME HEALTH AGENCY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2014
Last Update Date: 10/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13633 INGLEWOOD AVE
HAWTHORNE CA
90250-5610
US

IV. Provider business mailing address

16617 YUKON AVE
TORRANCE CA
90504-1314
US

V. Phone/Fax

Practice location:
  • Phone: 310-999-9118
  • Fax: 310-263-7896
Mailing address:
  • Phone: 310-999-9118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. IRFAN NIZAMI
Title or Position: CEO
Credential:
Phone: 310-999-9118