Healthcare Provider Details

I. General information

NPI: 1265553911
Provider Name (Legal Business Name): OCEAN SIDE HOME HEALTH SERVICES,INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 03/09/2023
Certification Date: 03/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4322 WILSHIRE BLVD SUITE 208
LOS ANGELES CA
90010-3793
US

IV. Provider business mailing address

4322 WILSHIRE BLVD SUITE 208
LOS ANGELES CA
90010-3793
US

V. Phone/Fax

Practice location:
  • Phone: 323-934-5050
  • Fax: 323-934-9850
Mailing address:
  • Phone: 323-934-5050
  • Fax: 323-934-9850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number45465
License Number StateCA

VIII. Authorized Official

Name: THOMAS TILAHUN
Title or Position: ADMINISTRATOR
Credential:
Phone: 323-934-5050