Provider Demographics
NPI:1528014982
Name:ACCENTCARE HOME HEALTH OF CALIFORNIA, INC.
Entity Type:Organization
Organization Name:ACCENTCARE HOME HEALTH OF CALIFORNIA, INC.
Other - Org Name:ACHH OF CA - NEWPORT BEACH
Other - Org Type:Other Name
Authorized Official - Title/Position:VP LEGAL
Authorized Official - Prefix:
Authorized Official - First Name:M'LISS
Authorized Official - Middle Name:JONES
Authorized Official - Last Name:KANE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-623-1582
Mailing Address - Street 1:17855 N. DALLAS PKWY.
Mailing Address - Street 2:SUITE 200
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75287-6857
Mailing Address - Country:US
Mailing Address - Phone:972-267-1100
Mailing Address - Fax:972-267-1116
Practice Address - Street 1:3636 BIRCH ST STE 195
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-2644
Practice Address - Country:US
Practice Address - Phone:949-250-0133
Practice Address - Fax:949-250-4472
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2019-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA060000027251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHHA70189FMedicaid
ZZZ61340ZOtherBLUE SHIELD
ZZZ61340ZOtherBLUE SHIELD