=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477844645
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HANKARE HEALTH SERVICES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/22/2011
-----------------------------------------------------
Last Update Date | 04/22/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7045 KITTYHAWK AVE
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90045-2103
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-435-7169
-----------------------------------------------------
Fax | 310-215-9240
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7045 KITTYHAWK AVE
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90045-2103
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-435-7169
-----------------------------------------------------
Fax | 310-215-9240
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | RODNEY V. INNIS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 310-863-5177
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------