Provider Demographics
NPI:1407209430
Name:RASSOULI HOMECARE LLC
Entity Type:Organization
Organization Name:RASSOULI HOMECARE LLC
Other - Org Name:ORANGE COUNTY CARE HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:FAHIMEH
Authorized Official - Middle Name:
Authorized Official - Last Name:RASSOULI ZADEHEI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-322-1078
Mailing Address - Street 1:24562 LOS SERRANOS DR
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-2125
Mailing Address - Country:US
Mailing Address - Phone:949-322-1078
Mailing Address - Fax:
Practice Address - Street 1:27561 ALMENDRA
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-1703
Practice Address - Country:US
Practice Address - Phone:949-206-0697
Practice Address - Fax:949-206-1096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-14
Last Update Date:2016-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA306004605251T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization