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General NPI Number Information
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NPI Number | 1194035428
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Entity Type | Organization
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Legal Business Name | IDEAL HEALTHCARE STAFF PROVIDERS
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Dates
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Enumeration Date | 10/20/2010
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Last Update Date | 10/20/2010
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Provider Practice Location Address
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Address Line | 3986 WESTSIDE AVE SUITE B
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City | LOS ANGELES
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State | CA
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Zip | 90008-2630
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Country | US
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Telephone | 213-603-1789
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Fax | 323-292-3529
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Provider Business Mailing Address
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Address Line | 3986 WESTSIDE AVE SUITE B
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City | LOS ANGELES
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State | CA
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Zip | 90008-2630
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Country | US
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Telephone | 213-603-1789
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Fax | 323-292-3529
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Authorized Official
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Title or Position | CEO
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Name | VICTOR OKECHUKWU AHAIWE
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Credential | LVN, BS
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Telephone | 213-603-1789
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | SRAS99897664
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License Number State | CA
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