Provider Demographics
NPI:1386818623
Name:LOS ANGELES HOMECARE LLC
Entity Type:Organization
Organization Name:LOS ANGELES HOMECARE LLC
Other - Org Name:SALUS HOMECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:MORTENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-725-8742
Mailing Address - Street 1:630 ROOSEVELT
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92620-3621
Mailing Address - Country:US
Mailing Address - Phone:888-725-8742
Mailing Address - Fax:
Practice Address - Street 1:15342 HAWTHORNE BLVD
Practice Address - Street 2:SUITE 211
Practice Address - City:LAWNDALE
Practice Address - State:CA
Practice Address - Zip Code:90260-2152
Practice Address - Country:US
Practice Address - Phone:888-725-8742
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-17
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA200714610180251E00000X
253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health