Healthcare Provider Details

I. General information

NPI: 1891320685
Provider Name (Legal Business Name): ULTRACARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2020
Last Update Date: 12/05/2023
Certification Date: 12/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1117 W MANCHESTER BLVD STE B
INGLEWOOD CA
90301-1588
US

IV. Provider business mailing address

8549 WILSHIRE BLVD # 151
BEVERLY HILLS CA
90211-3104
US

V. Phone/Fax

Practice location:
  • Phone: 818-266-9668
  • Fax:
Mailing address:
  • Phone: 310-691-8161
  • Fax: 888-797-5605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: LESLEE DEANES
Title or Position: OWNER
Credential:
Phone: 818-266-9668