MEDICARE: CTSH BURBANK, 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	:	1225720790
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CTSH BURBANK, LLC

Provider Business Mailing Address
First Line	:	640 N TUSTIN AVE STE 201
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92705-3783
Country	:	US
Telephone Number	:	949-916-6705
Fax Number	:	949-916-6785

Provider Business Practice Location Address
First Line	:	611 N BRAND BLVD STE 1300
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91203-3213
Country	:	US
Telephone Number	:	818-446-6966
Fax Number	:	949-916-6785

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	PARKER WELLS
Credential	:
Telephone Number	:	949-264-3447

Provider Enumeration Date	:	05/23/2023
Last Update Date	:	05/24/2023

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