MEDICARE: ACCENTCARE HOME HEALTH OF CALIFORNIA, 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	08-000479	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	HHA70195G	OTHER	CA	MEDI-CAL

General Provider Information

NPI Number	:	1740242718
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACCENTCARE HOME HEALTH OF CALIFORNIA, INC

Provider Business Mailing Address
First Line	:	17855 N. DALLAS PKWY.
Second Line	:	SUITE 200
City	:	DALLAS
State	:	TX
Zip	:	75287-6857
Country	:	US
Telephone Number	:	972-267-1100
Fax Number	:	972-267-1116

Provider Business Practice Location Address
First Line	:	2344 S 2ND ST STE A
Second Line	:
City	:	EL CENTRO
State	:	CA
Zip	:	92243-5606
Country	:	US
Telephone Number	:	760-352-4022
Fax Number	:

Authorized Official
Title or Position	:	PARALEGAL
Name	:	REENE COWAN
Credential	:
Telephone Number	:	972-201-3779

Provider Enumeration Date	:	04/05/2006
Last Update Date	:	03/20/2020

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