Healthcare Provider Details

I. General information

NPI: 1790625853
Provider Name (Legal Business Name): SANTA MONICA IN HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2026
Last Update Date: 03/30/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11845 W OLYMPIC BLVD STE 1100W
LOS ANGELES CA
90064-5036
US

IV. Provider business mailing address

PO BOX 66655
LOS ANGELES CA
90066-0655
US

V. Phone/Fax

Practice location:
  • Phone: 310-691-5637
  • Fax:
Mailing address:
  • Phone: 310-691-5637
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State

VIII. Authorized Official

Name: PHIL MASON
Title or Position: OWNER
Credential:
Phone: 310-691-5637