MEDICARE: LOAD RUNNERS 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		CA

General Provider Information

NPI Number	:	1285870063
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOAD RUNNERS LLC

Provider Business Mailing Address
First Line	:	6303 OWENSMOUTH AVE STE 2004
Second Line	:
City	:	WOODLAND HILLS
State	:	CA
Zip	:	91367-2264
Country	:	US
Telephone Number	:	818-745-3887
Fax Number	:

Provider Business Practice Location Address
First Line	:	6303 OWENSMOUTH AVE STE 2004
Second Line	:
City	:	WOODLAND HILLS
State	:	CA
Zip	:	91367-2264
Country	:	US
Telephone Number	:	818-745-3887
Fax Number	:	818-745-3887

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	KENNETH CLARK
Credential	:
Telephone Number	:	818-745-3887

Provider Enumeration Date	:	12/27/2008
Last Update Date	:	10/20/2010

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