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NPI Code Detail

MEDICARE: JEFFERSON HOMES SLS, LLC

MEDICARE: JEFFERSON HOMES SLS, 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
1251E00000XHome Health Agency
2253Z00000XIn Home Supportive Care Agency

General Provider Information

NPI Number : 1730048745
Entity Type Code : Organization
Provider Name (Legal Business Name) : JEFFERSON HOMES SLS, LLC
Provider Business Mailing Address
First Line : 6201 W 87TH ST # 2681
Second Line :
City : LOS ANGELES
State : CA
Zip : 90045-3901
Country : US
Telephone Number : 818-963-0079
Fax Number :
Provider Business Practice Location Address
First Line : 6201 W 87TH ST # 2681
Second Line :
City : LOS ANGELES
State : CA
Zip : 90045-3901
Country : US
Telephone Number : 818-963-0079
Fax Number :
Authorized Official
Title or Position : MANAGING MEMBER
Name : MR. CORNELL JEFFERSON
Credential : ADMINISTRATOR
Telephone Number : 818-963-0079
Provider Enumeration Date : 01/16/2026
Last Update Date : 01/16/2026

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Directions to “JEFFERSON HOMES SLS, LLC ” Practice Location

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