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NPI Code Detail

MEDICARE: LSA EXCLUSIVE LLC

MEDICARE: LSA EXCLUSIVE 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
1253Z00000XIn Home Supportive Care Agency

General Provider Information

NPI Number : 1184268302
Entity Type Code : Organization
Provider Name (Legal Business Name) : LSA EXCLUSIVE LLC
Provider Business Mailing Address
First Line : 18948 LASSEN ST
Second Line :
City : NORTHRIDGE
State : CA
Zip : 91324-1835
Country : US
Telephone Number : 323-423-0054
Fax Number :
Provider Business Practice Location Address
First Line : 6320 CANOGA AVE STE 1500
Second Line :
City : WOODLAND HILLS
State : CA
Zip : 91367-2517
Country : US
Telephone Number : 323-423-0054
Fax Number :
Authorized Official
Title or Position : MANAGING MEMBER
Name : SHABANA AZMI JAMEEL AHAMED
Credential :
Telephone Number : 323-423-0054
Provider Enumeration Date : 10/31/2019
Last Update Date : 10/31/2019

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Directions to “LSA EXCLUSIVE LLC ” Practice Location

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