Provider Demographics
NPI:1295019669
Name:LA WELLNESS HEALTH CARE, INC.
Entity Type:Organization
Organization Name:LA WELLNESS HEALTH CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:IRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:ISOUNTS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:818-762-6777
Mailing Address - Street 1:5652 VINELAND AVE
Mailing Address - Street 2:SUITE 202A
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91601-2061
Mailing Address - Country:US
Mailing Address - Phone:818-762-6777
Mailing Address - Fax:818-762-8777
Practice Address - Street 1:5652 VINELAND AVE
Practice Address - Street 2:SUITE 202A
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91601-2061
Practice Address - Country:US
Practice Address - Phone:818-762-6777
Practice Address - Fax:818-762-8777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-04
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
059751Medicare Oscar/Certification