MEDICARE: INTRA CARE HOME HEALTH PROVIDERS 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	251E00000X	Home Health Agency	980001387	CA

General Provider Information

NPI Number	:	1700871233
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTRA CARE HOME HEALTH PROVIDERS INC

Provider Business Mailing Address
First Line	:	4929 WILSHIRE BLVD
Second Line	:	SUITE 210
City	:	LOS ANGELES
State	:	CA
Zip	:	90010-3808
Country	:	US
Telephone Number	:	323-964-0884
Fax Number	:	323-857-7206

Provider Business Practice Location Address
First Line	:	4929 WILSHIRE BLVD
Second Line	:	SUITE 210
City	:	LOS ANGELES
State	:	CA
Zip	:	90010-3808
Country	:	US
Telephone Number	:	323-964-0884
Fax Number	:	323-857-7206

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MS. DIONALYN UGBEBOR
Credential	:	RN,BSN
Telephone Number	:	323-964-0884

Provider Enumeration Date	:	09/12/2005
Last Update Date	:	11/07/2018

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