Provider Demographics
NPI:1194035428
Name:IDEAL HEALTHCARE STAFF PROVIDERS
Entity Type:Organization
Organization Name:IDEAL HEALTHCARE STAFF PROVIDERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:OKECHUKWU
Authorized Official - Last Name:AHAIWE
Authorized Official - Suffix:
Authorized Official - Credentials:LVN, BS
Authorized Official - Phone:213-603-1789
Mailing Address - Street 1:3986 WESTSIDE AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90008-2630
Mailing Address - Country:US
Mailing Address - Phone:213-603-1789
Mailing Address - Fax:323-292-3529
Practice Address - Street 1:3986 WESTSIDE AVE
Practice Address - Street 2:SUITE B
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90008-2630
Practice Address - Country:US
Practice Address - Phone:213-603-1789
Practice Address - Fax:323-292-3529
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-20
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASRAS99897664251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health