MEDICARE: 360 CAREGIVERS HOME AGENCY 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	:	1598377871
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	360 CAREGIVERS HOME AGENCY LLC

Provider Business Mailing Address
First Line	:	15870 CAMINO SAN BERNARDO APT 133
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92127-2367
Country	:	US
Telephone Number	:	619-519-4902
Fax Number	:

Provider Business Practice Location Address
First Line	:	15870 CAMINO SAN BERNARDO APT 133
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92127-2367
Country	:	US
Telephone Number	:	619-519-4902
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ARASH SHARIFI
Credential	:
Telephone Number	:	619-519-4902

Provider Enumeration Date	:	08/19/2020
Last Update Date	:	08/19/2020

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