Provider Demographics
NPI:1518348481
Name:PRIME HEALTHCARE SERVICES-SHERMAN OAKS, LLC
Entity Type:Organization
Organization Name:PRIME HEALTHCARE SERVICES-SHERMAN OAKS, LLC
Other - Org Name:SPECIALIZED AMBULATORY GERIATRIC EVALUATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF COMPLIANCE COUNSEL
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:DOAN
Authorized Official - Suffix:
Authorized Official - Credentials:ESQ
Authorized Official - Phone:909-235-4307
Mailing Address - Street 1:4929 VAN NUYS BLVD
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-1702
Mailing Address - Country:US
Mailing Address - Phone:818-961-7111
Mailing Address - Fax:818-907-2829
Practice Address - Street 1:4911 VAN NUYS BLVD
Practice Address - Street 2:SUITE 307
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-1716
Practice Address - Country:US
Practice Address - Phone:818-341-7243
Practice Address - Fax:818-478-2925
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRIME HEALTHCARE SERVICES-SHERMAN OAKS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-06-16
Last Update Date:2015-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA930000149163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty