Provider Demographics
NPI:1417987322
Name:CARING HANDS HOME HEALTH AGENCY, INC.
Entity Type:Organization
Organization Name:CARING HANDS HOME HEALTH AGENCY, INC.
Other - Org Name:CARING HANDS HOME HEALTH SERVICE, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:ADMINISTRATOR / DOPCS
Authorized Official - Prefix:MS
Authorized Official - First Name:MAXINE
Authorized Official - Middle Name:LANEAL
Authorized Official - Last Name:DEMARKS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:310-258-0258
Mailing Address - Street 1:5701 W SLAUSON AVE
Mailing Address - Street 2:100
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90230-6523
Mailing Address - Country:US
Mailing Address - Phone:310-258-0258
Mailing Address - Fax:310-258-0298
Practice Address - Street 1:5701 W SLAUSON AVE
Practice Address - Street 2:100
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90230-6523
Practice Address - Country:US
Practice Address - Phone:310-258-0258
Practice Address - Fax:310-258-0298
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2012-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA980001440251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHHA08160FMedicaid
CAHHA08160FMedicaid