MEDICARE: AC HOME CARE SERVICES PRIVATE INC

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	980000735	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134437247
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AC HOME CARE SERVICES PRIVATE INC

Provider Business Mailing Address
First Line	:	3870 CRENSHAW BLVD STE 209
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90008-1815
Country	:	US
Telephone Number	:	323-294-5189
Fax Number	:	323-293-0047

Provider Business Practice Location Address
First Line	:	3870 CRENSHAW BLVD STE 209
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90008-1815
Country	:	US
Telephone Number	:	323-294-5189
Fax Number	:	323-293-0047

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. AMELIA M CAMPBELL
Credential	:	RN MS
Telephone Number	:	323-294-5189

Provider Enumeration Date	:	09/23/2010
Last Update Date	:	09/23/2010

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Directions to “AC HOME CARE SERVICES PRIVATE INC ” Practice Location

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