MEDICARE: LOLI IN-HOME 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	194700013	CA
2	253Z00000X	In Home Supportive Care Agency	194700013	CA

General Provider Information

NPI Number	:	1114464807
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOLI IN-HOME CARE LLC

Provider Business Mailing Address
First Line	:	2409 N SEPULVEDA BLVD
Second Line	:	SUITE # 301
City	:	MANHATTAN BEACH
State	:	CA
Zip	:	90266-2947
Country	:	US
Telephone Number	:	310-546-3400
Fax Number	:	310-546-3409

Provider Business Practice Location Address
First Line	:	2409 N SEPULVEDA BLVD
Second Line	:	SUITE # 301
City	:	MANHATTAN BEACH
State	:	CA
Zip	:	90266-2947
Country	:	US
Telephone Number	:	310-546-3400
Fax Number	:	310-546-3409

Authorized Official
Title or Position	:	OWNER
Name	:	LOLI RAMEZANI
Credential	:
Telephone Number	:	310-546-3400

Provider Enumeration Date	:	01/19/2017
Last Update Date	:	01/19/2017

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