=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518990050
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BLUESCOPE HEALTH PROFESSIONAL INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/08/2006
-----------------------------------------------------
Last Update Date | 04/01/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 18051 CRENSHAW BLVD SUITE B
-----------------------------------------------------
City | TORRANCE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90504-5138
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-366-1306
-----------------------------------------------------
Fax | 310-366-7283
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 18051 CRENSHAW BLVD SUITE B
-----------------------------------------------------
City | TORRANCE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90504-5138
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-366-1306
-----------------------------------------------------
Fax | 310-366-7283
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MRS. FRANCES E CHILAKA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 310-366-1306
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number | 103339
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number | 5061640001
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------