Healthcare Provider Details

I. General information

NPI: 1366683096
Provider Name (Legal Business Name): LVN/INHOME CARE NURSING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2009
Last Update Date: 03/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 WORLD TRADE CTR SUITE 800
LONG BEACH CA
90831-0002
US

IV. Provider business mailing address

1 WORLD TRADE CTR SUITE 800
LONG BEACH CA
90831-0002
US

V. Phone/Fax

Practice location:
  • Phone: 866-508-2236
  • Fax: 619-330-2153
Mailing address:
  • Phone: 866-508-2236
  • Fax: 619-330-2153

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. GASTON PHILLIPS
Title or Position: DIRECTOR OF IN HOME CARE SERVICES
Credential:
Phone: 866-508-2236