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General NPI Number Information
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NPI Number | 1205011335
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Entity Type | Organization
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Legal Business Name | AQUILA HEALTHCARE SYSTEMS, LLC
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Dates
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Enumeration Date | 01/08/2008
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Last Update Date | 02/02/2023
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Provider Practice Location Address
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Address Line | 3450 WILSHIRE BLVD SUITE 1000
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City | LOS ANGELES
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State | CA
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Zip | 90010-2208
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Country | US
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Telephone | 213-380-1399
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Fax |
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Provider Business Mailing Address
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Address Line | 400 CORPORATE POINTE STE 300
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City | CULVER CITY
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State | CA
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Zip | 90230-7620
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Country | US
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Telephone | 213-380-1399
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Fax | 323-380-4046
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Authorized Official
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Title or Position | MANAGER
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Name | MR. DAMON CLARK
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Credential |
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Telephone | 213-380-1399
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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 | 980000772
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License Number State | CA
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