Healthcare Provider Details

I. General information

NPI: 1376476812
Provider Name (Legal Business Name): CAMINO HOME HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

979 MARVIEW AVE
LOS ANGELES CA
90012-1255
US

IV. Provider business mailing address

979 MARVIEW AVE
LOS ANGELES CA
90012-1255
US

V. Phone/Fax

Practice location:
  • Phone: 831-345-7332
  • Fax:
Mailing address:
  • Phone:
  • 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: TYLER EDWARDS
Title or Position: MANAGER
Credential:
Phone: 831-345-7332