Healthcare Provider Details

I. General information

NPI: 1114927985
Provider Name (Legal Business Name): OCEAN SIDE HOME HEALTH SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2005
Last Update Date: 02/22/2023
Certification Date: 02/22/2023
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 TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number45465
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number980001353
License Number StateCA

VIII. Authorized Official

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