Healthcare Provider Details

I. General information

NPI: 1538310818
Provider Name (Legal Business Name): INNOVATIVE SENIOR CARE HOME HEALTH OF LOS ANGELES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2008
Last Update Date: 04/11/2023
Certification Date: 04/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 W KIMBERLY AVE STE 190
PLACENTIA CA
92870-6332
US

IV. Provider business mailing address

111 WESTWOOD PL
BRENTWOOD TN
37027-5021
US

V. Phone/Fax

Practice location:
  • Phone: 714-364-6525
  • Fax:
Mailing address:
  • Phone: 615-221-2250
  • Fax: 615-221-2280

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: BRAD PARRISH
Title or Position: CFO, HOME HEALTH & HOSPICE
Credential:
Phone: 615-344-6955