=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861503161
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHARITY HOME HEALTH SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/31/2006
-----------------------------------------------------
Last Update Date | 06/15/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 500 E CARSON PLAZA DR #228
-----------------------------------------------------
City | CARSON
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90746-3225
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-527-4339
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 500 E CARSON PLAZA DR #228
-----------------------------------------------------
City | CARSON
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90746-3225
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-527-4339
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MR. TOBENNA ONWUNYI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 310-527-4339
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 980001063
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------