Provider Demographics
NPI:1538310818
Name:INNOVATIVE SENIOR CARE HOME HEALTH OF LOS ANGELES LLC
Entity Type:Organization
Organization Name:INNOVATIVE SENIOR CARE HOME HEALTH OF LOS ANGELES LLC
Other - Org Name:BROOKDALE HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO, HOME HEALTH & HOSPICE
Authorized Official - Prefix:
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:
Authorized Official - Last Name:PARRISH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-344-6955
Mailing Address - Street 1:111 WESTWOOD PL
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-5021
Mailing Address - Country:US
Mailing Address - Phone:615-221-2250
Mailing Address - Fax:615-221-2280
Practice Address - Street 1:701 W KIMBERLY AVE STE 190
Practice Address - Street 2:
Practice Address - City:PLACENTIA
Practice Address - State:CA
Practice Address - Zip Code:92870-6332
Practice Address - Country:US
Practice Address - Phone:714-364-6525
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-06
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ557696Medicare Oscar/Certification