Provider Demographics
NPI:1205011335
Name:AQUILA HEALTHCARE SYSTEMS, LLC
Entity Type:Organization
Organization Name:AQUILA HEALTHCARE SYSTEMS, LLC
Other - Org Name:TOTAL CARE NURSING SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAMON
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-380-1399
Mailing Address - Street 1:3450 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 1000
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90010-2208
Mailing Address - Country:US
Mailing Address - Phone:213-380-1399
Mailing Address - Fax:
Practice Address - Street 1:3450 WILSHIRE BLVD
Practice Address - Street 2:SUITE 1000
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90010-2208
Practice Address - Country:US
Practice Address - Phone:213-380-1399
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-08
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA200320310073OtherCALIFORNIA LLC NUMBER