=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518389956
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COMPREHENSIVE IN-HOME HEALTHCARE SERVICES, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/18/2014
-----------------------------------------------------
Last Update Date | 01/18/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13517 S MENLO AVE
-----------------------------------------------------
City | GARDENA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90247-2133
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-709-3680
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9595 WILSHIRE BLVD SUITE 900
-----------------------------------------------------
City | BEVERLY HILLS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90212-2512
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-492-4322
-----------------------------------------------------
Fax | 310-492-4323
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MS. STEPHANIE HICKS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 310-709-3680
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------