Healthcare Provider Details

I. General information

NPI: 1275009102
Provider Name (Legal Business Name): HSERVICES 5505, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2018
Last Update Date: 10/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 E WALNUT ST STE 228
PASADENA CA
91106-5312
US

IV. Provider business mailing address

1000 E WALNUT ST STE 228
PASADENA CA
91106-5312
US

V. Phone/Fax

Practice location:
  • Phone: 626-799-4855
  • Fax:
Mailing address:
  • Phone: 626-799-4855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: SHANE RYAN HULL
Title or Position: PRESIDENT
Credential:
Phone: 626-799-4855