MEDICARE: SANTA MONICA IN HOME CARE 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	251K00000X	Public Health or Welfare Agency

General Provider Information

NPI Number	:	1790625853
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SANTA MONICA IN HOME CARE LLC

Provider Business Mailing Address
First Line	:	PO BOX 66655
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90066-0655
Country	:	US
Telephone Number	:	310-691-5637
Fax Number	:

Provider Business Practice Location Address
First Line	:	11845 W OLYMPIC BLVD STE 1100W
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90064-5036
Country	:	US
Telephone Number	:	310-691-5637
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	PHIL MASON
Credential	:
Telephone Number	:	310-691-5637

Provider Enumeration Date	:	03/30/2026
Last Update Date	:	03/30/2026

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