Provider Demographics
NPI:1376729483
Name:ACCENTCARE HOME HEALTH OF CALIFORNIA, INC.
Entity Type:Organization
Organization Name:ACCENTCARE HOME HEALTH OF CALIFORNIA, INC.
Other - Org Name:ACHH OF CA - WEST COVINA
Other - Org Type:Other Name
Authorized Official - Title/Position:VP LEGAL
Authorized Official - Prefix:
Authorized Official - First Name:M'LISS
Authorized Official - Middle Name:JONES
Authorized Official - Last Name:KANE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-623-1582
Mailing Address - Street 1:17855 DALLAS PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75287-6857
Mailing Address - Country:US
Mailing Address - Phone:972-201-6000
Mailing Address - Fax:
Practice Address - Street 1:2934 E GARVEY AVE S STE 210
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91791
Practice Address - Country:US
Practice Address - Phone:626-966-2545
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-18
Last Update Date:2023-12-13
Deactivation Date:2018-07-23
Deactivation Code:
Reactivation Date:2018-07-25
Provider Licenses
StateLicense IDTaxonomies
CA980000845251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHHA57463IMedicaid
CAHHA57463KMedicaid