Provider Demographics
NPI:1376783282
Name:EASTWEST HOMECARE LOS ANGELES
Entity Type:Organization
Organization Name:EASTWEST HOMECARE LOS ANGELES
Other - Org Name:INTERIM HEALTHCARE POMONA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-207-6970
Mailing Address - Street 1:456 W SAN JOSE AVE
Mailing Address - Street 2:B
Mailing Address - City:CLAREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:91711-6009
Mailing Address - Country:US
Mailing Address - Phone:909-267-3383
Mailing Address - Fax:909-267-3386
Practice Address - Street 1:456 W SAN JOSE AVE
Practice Address - Street 2:B
Practice Address - City:CLAREMONT
Practice Address - State:CA
Practice Address - Zip Code:91711-6009
Practice Address - Country:US
Practice Address - Phone:909-267-3383
Practice Address - Fax:909-267-3386
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EASTWEST HOMECARE LOS ANGELES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-03-05
Last Update Date:2009-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA980000491251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHHA076907FMedicaid