Provider Demographics
NPI:1255310900
Name:HOME HEALTH INTEGRATED SERVICES, INC
Entity Type:Organization
Organization Name:HOME HEALTH INTEGRATED SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT /CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:AEGEAN
Authorized Official - Middle Name:JAIME
Authorized Official - Last Name:CAROLINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-558-6685
Mailing Address - Street 1:704 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91506-2529
Mailing Address - Country:US
Mailing Address - Phone:818-558-6685
Mailing Address - Fax:818-558-6718
Practice Address - Street 1:704 S MAIN ST
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91506-2529
Practice Address - Country:US
Practice Address - Phone:818-558-6685
Practice Address - Fax:818-558-6718
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-11
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA980000859251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHHA57473GMedicaid
CAHHA57473GMedicaid