Provider Demographics
NPI:1073732590
Name:PALMIRA DEVELOPMENT, INC.
Entity Type:Organization
Organization Name:PALMIRA DEVELOPMENT, INC.
Other - Org Name:PROFESSIONAL HOME CARE SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:VIKTORIYA
Authorized Official - Middle Name:
Authorized Official - Last Name:KUSHNIR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-285-1848
Mailing Address - Street 1:520 S LA FAYETTE PARK PL STE 570
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90057-5420
Mailing Address - Country:US
Mailing Address - Phone:213-385-1848
Mailing Address - Fax:213-385-5418
Practice Address - Street 1:520 S LA FAYETTE PARK PL STE 570
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-5420
Practice Address - Country:US
Practice Address - Phone:213-385-1848
Practice Address - Fax:213-385-5418
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2015-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA550000372251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health