MEDICARE: EKPELE NURSING & STAFFING PROVIDER 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	3158591	CA

General Provider Information

NPI Number	:	1871735670
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EKPELE NURSING & STAFFING PROVIDER INC.

Provider Business Mailing Address
First Line	:	1550 STADIUM WAY
Second Line	:	UNIT 5
City	:	LOS ANGELES
State	:	CA
Zip	:	90012-1174
Country	:	US
Telephone Number	:	323-226-9091
Fax Number	:	323-223-2095

Provider Business Practice Location Address
First Line	:	1550 STADIUM WAY
Second Line	:	UNIT 5
City	:	LOS ANGELES
State	:	CA
Zip	:	90012-1174
Country	:	US
Telephone Number	:	323-226-9091
Fax Number	:	323-223-2095

Authorized Official
Title or Position	:	DIRECTOR/CFO
Name	:	HUMPHREY AWANZIA NEZIANYA
Credential	:	BSHS/CNA
Telephone Number	:	323-226-9091

Provider Enumeration Date	:	03/25/2009
Last Update Date	:	03/25/2009

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