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General NPI Number Information
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NPI Number | 1669680435
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Entity Type | Organization
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Legal Business Name | DYNASTY CARE HOME HEALTH, INC.
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Dates
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Enumeration Date | 05/17/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 8929 S SEPULVEDA BLVD SUITE 204
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City | LOS ANGELES
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State | CA
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Zip | 90045-3616
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Country | US
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Telephone | 310-410-9998
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Fax | 310-410-9995
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Provider Business Mailing Address
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Address Line | 8929 S SEPULVEDA BLVD SUITE 204
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City | LOS ANGELES
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State | CA
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Zip | 90045-3616
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Country | US
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Telephone | 310-410-9998
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Fax | 310-410-9995
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. MARILOU M LUGTU
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Credential | RN
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Telephone | 310-410-9998
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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 |
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License Number State |
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