Provider Demographics
NPI:1376563858
Name:MISSION HOME HEALTH SERVICES, INC
Entity Type:Organization
Organization Name:MISSION HOME HEALTH SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DPCS
Authorized Official - Prefix:MRS
Authorized Official - First Name:YOUNG
Authorized Official - Middle Name:SOOK
Authorized Official - Last Name:UM
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:213-387-4663
Mailing Address - Street 1:505 S. VIRGIL AVE
Mailing Address - Street 2:SUITE 305
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90020-1455
Mailing Address - Country:US
Mailing Address - Phone:213-387-4663
Mailing Address - Fax:
Practice Address - Street 1:505 S. VIRGIL AVE
Practice Address - Street 2:SUITE 305
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90020-1455
Practice Address - Country:US
Practice Address - Phone:213-387-4663
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA980001333251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHHA08131GMedicaid
CAHH980002211OtherHOME HEALTH ID NUMBER
CA058131Medicare UPIN