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General NPI Number Information
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NPI Number | 1417130865
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Entity Type | Organization
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Legal Business Name | ASSOCIATED HEALTHCARE AGENCY
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Dates
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Enumeration Date | 12/07/2007
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Last Update Date | 12/07/2007
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Provider Practice Location Address
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Address Line | 4146 E OLYMPIC BLVD STE B
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City | LOS ANGELES
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State | CA
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Zip | 90023-3347
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Country | US
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Telephone | 323-262-9948
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Fax | 323-262-3708
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Provider Business Mailing Address
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Address Line | 27508 WALNUT SPRINGS AVE
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City | CANYON COUNTRY
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State | CA
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Zip | 91351-2822
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Country | US
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Telephone | 661-299-2291
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Fax |
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Authorized Official
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Title or Position | RESPIRATORY CARE PRACTITIONER
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Name | MR. GEORGE WASHINGTON JR.
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Credential | RCP
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Telephone | 818-232-2875
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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 | 13861
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License Number State | CA
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