MEDICARE: HEMMA, 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	315P00000X	Intellectual Disabilities Intermediate Care Facility	960000857	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	LTC60589F	OTHER	CA	PROVIDER NUMBER

General Provider Information

NPI Number	:	1215143060
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEMMA, INC

Provider Business Mailing Address
First Line	:	PO BOX 6086
Second Line	:
City	:	IRVINE
State	:	CA
Zip	:	92616-6086
Country	:	US
Telephone Number	:	949-648-9395
Fax Number	:

Provider Business Practice Location Address
First Line	:	1922 N MOUNTAIN AVE
Second Line	:
City	:	CLAREMONT
State	:	CA
Zip	:	91711-2605
Country	:	US
Telephone Number	:	909-624-2437
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	RICHARD AARON CARLSON
Credential	:
Telephone Number	:	949-648-9395

Provider Enumeration Date	:	05/15/2007
Last Update Date	:	04/23/2008

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Directions to “HEMMA, INC ” Practice Location

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