MEDICARE: OCEAN PARK ENTERPRISES, 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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1083569313
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OCEAN PARK ENTERPRISES, LLC

Provider Business Mailing Address
First Line	:	11600 WASHINGTON PL PH 2
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90066-5033
Country	:	US
Telephone Number	:	310-956-4811
Fax Number	:	310-933-4415

Provider Business Practice Location Address
First Line	:	11600 WASHINGTON PL PH 2
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90066-5033
Country	:	US
Telephone Number	:	310-956-4811
Fax Number	:	310-933-4415

Authorized Official
Title or Position	:	OWNER
Name	:	MR. JASON TAYLOR
Credential	:
Telephone Number	:	310-956-4811

Provider Enumeration Date	:	03/02/2026
Last Update Date	:	03/02/2026

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