Provider Demographics
NPI:1033241773
Name:THE HOME CARE GROUP, INC
Entity Type:Organization
Organization Name:THE HOME CARE GROUP, INC
Other - Org Name:THE HOME CARE GROUP, INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANJELA
Authorized Official - Middle Name:
Authorized Official - Last Name:AGADJANOVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-516-9255
Mailing Address - Street 1:20620 LEAPWOOD AVE STE L
Mailing Address - Street 2:
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90746-3668
Mailing Address - Country:US
Mailing Address - Phone:310-516-9255
Mailing Address - Fax:310-516-8299
Practice Address - Street 1:20620 LEAPWOOD AVE STE L
Practice Address - Street 2:
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90746
Practice Address - Country:US
Practice Address - Phone:310-516-9255
Practice Address - Fax:310-516-8299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2018-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA980001322251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHHA08072Medicaid
CA058072Medicare Oscar/Certification