Healthcare Provider Details

I. General information

NPI: 1649263492
Provider Name (Legal Business Name): CCAM, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2005
Last Update Date: 10/16/2024
Certification Date: 10/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8929 S SEPULVEDA BLVD #306
WESTCHESTER CA
90045-3616
US

IV. Provider business mailing address

8929 S SEPULVEDA BLVD #306
WESTCHESTER CA
90045-3616
US

V. Phone/Fax

Practice location:
  • Phone: 310-641-4100
  • Fax: 310-670-9944
Mailing address:
  • Phone: 310-641-4100
  • Fax: 310-670-9944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number980001124
License Number StateCA

VIII. Authorized Official

Name: MS. OMID GABBAI
Title or Position: CEO
Credential:
Phone: 310-641-4100