Provider Demographics
NPI:1093479602
Name:MERIT LIFE OF ASPIRATIONS HOME CARE LLC
Entity Type:Organization
Organization Name:MERIT LIFE OF ASPIRATIONS HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PEARL
Authorized Official - Middle Name:
Authorized Official - Last Name:GAMBOA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-301-8580
Mailing Address - Street 1:1001 WILSHIRE BLVD STE 114
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90017-2821
Mailing Address - Country:US
Mailing Address - Phone:323-301-8580
Mailing Address - Fax:
Practice Address - Street 1:1001 WILSHIRE BLVD STE 114
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017-2821
Practice Address - Country:US
Practice Address - Phone:323-301-8580
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-29
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care