=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326399296
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HEALTHFLEX HOME HEALTH SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/01/2012
-----------------------------------------------------
Last Update Date | 06/02/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7677 OAKPORT ST STE 930
-----------------------------------------------------
City | OAKLAND
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94621-1929
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-553-1900
-----------------------------------------------------
Fax | 510-553-1906
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7677 OAKPORT ST STE 930
-----------------------------------------------------
City | OAKLAND
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94621-1929
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-912-8885
-----------------------------------------------------
Fax | 510-553-1906
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. ALEXANDER KOSHEVATSKY
-----------------------------------------------------
Credential | ADMINISTRATOR
-----------------------------------------------------
Telephone | 510-553-1900
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------