Provider Demographics
NPI: | 1518578251 |
---|---|
Name: | EPAK LLC |
Entity Type: | Organization |
Organization Name: | EPAK LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | ADMINISTRATOR |
Authorized Official - Prefix: | MR |
Authorized Official - First Name: | MARK |
Authorized Official - Middle Name: | DWAYNE |
Authorized Official - Last Name: | JACKSON |
Authorized Official - Suffix: | II |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 310-999-8113 |
Mailing Address - Street 1: | 6327 GIOVANNI WAY |
Mailing Address - Street 2: | |
Mailing Address - City: | PALMDALE |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 93551 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 310-999-8113 |
Mailing Address - Fax: | 661-206-5039 |
Practice Address - Street 1: | 6327 GIOVANNI WAY |
Practice Address - Street 2: | |
Practice Address - City: | PALMDALE |
Practice Address - State: | CA |
Practice Address - Zip Code: | 93551 |
Practice Address - Country: | US |
Practice Address - Phone: | 310-999-8113 |
Practice Address - Fax: | 661-206-5039 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2020-08-16 |
Last Update Date: | 2020-08-16 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 163WH0200X | Nursing Service Providers | Registered Nurse | Home Health | Group - Multi-Specialty |
No | 163WH1000X | Nursing Service Providers | Registered Nurse | Hospice | Group - Multi-Specialty |