MEDICARE: TANYA IN HOME HEALTH CARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency		CA

General Provider Information

NPI Number	:	1013351451
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TANYA IN HOME HEALTH CARE LLC

Provider Business Mailing Address
First Line	:	11400 W OLYMPIC BLVD
Second Line	:	200
City	:	LOS ANGELES
State	:	CA
Zip	:	90064-1550
Country	:	US
Telephone Number	:	323-445-8856
Fax Number	:	323-296-0368

Provider Business Practice Location Address
First Line	:	11400 W OLYMPIC BLVD
Second Line	:	200
City	:	LOS ANGELES
State	:	CA
Zip	:	90064-1550
Country	:	US
Telephone Number	:	323-445-8856
Fax Number	:	323-296-0368

Authorized Official
Title or Position	:	NURSE
Name	:	MRS. TANYA DENISE TILLETT
Credential	:	CNA
Telephone Number	:	323-868-8116

Provider Enumeration Date	:	04/27/2013
Last Update Date	:	06/03/2013

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