Provider Demographics
NPI:1447232335
Name:HOME REHABILITATION HEALTHCARE AGENCY INC.
Entity Type:Organization
Organization Name:HOME REHABILITATION HEALTHCARE AGENCY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF NURSING ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JOY
Authorized Official - Middle Name:
Authorized Official - Last Name:TYSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN BSN
Authorized Official - Phone:310-677-4400
Mailing Address - Street 1:644 E REGENT ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90301-1433
Mailing Address - Country:US
Mailing Address - Phone:310-677-4400
Mailing Address - Fax:310-677-4407
Practice Address - Street 1:644 E REGENT ST
Practice Address - Street 2:SUITE 101
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301-4502
Practice Address - Country:US
Practice Address - Phone:310-677-4400
Practice Address - Fax:310-677-4407
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-16
Last Update Date:2016-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA980001566251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5371136Medicaid
CA058265Medicare Oscar/Certification