Provider Demographics
NPI:1508820697
Name:AC HOME HEALTH AGENCY, INC
Entity Type:Organization
Organization Name:AC HOME HEALTH AGENCY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:AMELIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:BSN, RN, MS
Authorized Official - Phone:323-294-5189
Mailing Address - Street 1:5601 W SLAUSON AVE
Mailing Address - Street 2:SUITE 235
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90230-6582
Mailing Address - Country:US
Mailing Address - Phone:323-294-5189
Mailing Address - Fax:424-789-8118
Practice Address - Street 1:5601 W SLAUSON AVE
Practice Address - Street 2:SUITE 235
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90230-6582
Practice Address - Country:US
Practice Address - Phone:323-294-5189
Practice Address - Fax:424-789-8118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-14
Last Update Date:2015-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA980000735251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHHA07433GMedicaid
CA057433Medicare Oscar/Certification