Provider Demographics
NPI:1417049354
Name:SPECIALIZED HEALTH CARE SERVICES, INC.
Entity Type:Organization
Organization Name:SPECIALIZED HEALTH CARE SERVICES, INC.
Other - Org Name:SPECIALIZED HOME HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DIONALYN
Authorized Official - Middle Name:C
Authorized Official - Last Name:UGBEBOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-500-3929
Mailing Address - Street 1:1540 W GLENOAKS BLVD STE 104
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91201-3156
Mailing Address - Country:US
Mailing Address - Phone:818-500-3929
Mailing Address - Fax:818-500-3927
Practice Address - Street 1:1540 W GLENOAKS BLVD STE 104
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91201-3156
Practice Address - Country:US
Practice Address - Phone:818-500-3929
Practice Address - Fax:818-500-3927
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2014-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA058422Medicare Oscar/Certification