Provider Demographics
NPI:1386834174
Name:HOLISTIC CARE HOME HEALTH AGENCY, INC
Entity Type:Organization
Organization Name:HOLISTIC CARE HOME HEALTH AGENCY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ERIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:RENDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-755-8800
Mailing Address - Street 1:700 N. BRAND BLVD,
Mailing Address - Street 2:STE: 220
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91203
Mailing Address - Country:US
Mailing Address - Phone:818-755-8800
Mailing Address - Fax:818-755-8808
Practice Address - Street 1:700 N. BRAND BLVD
Practice Address - Street 2:STE: 220
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203
Practice Address - Country:US
Practice Address - Phone:818-755-8800
Practice Address - Fax:818-755-8808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-27
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA550001040251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPENDINGMedicare UPIN