Provider Demographics
NPI:1578516522
Name:INTRA CARE HOME HEALTH SFV, INC.
Entity Type:Organization
Organization Name:INTRA CARE HOME HEALTH SFV, INC.
Other - Org Name:INTRA CARE HOME HEALTH SFV, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIONALYN
Authorized Official - Middle Name:C
Authorized Official - Last Name:UGBEBOR
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:323-782-0239
Mailing Address - Street 1:18401 BURBANK BLVD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-2822
Mailing Address - Country:US
Mailing Address - Phone:323-782-0239
Mailing Address - Fax:323-782-8194
Practice Address - Street 1:18401 BURBANK BLVD
Practice Address - Street 2:SUITE 120
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-2822
Practice Address - Country:US
Practice Address - Phone:323-782-0239
Practice Address - Fax:323-782-8194
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA980001307251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHHA08055GMedicaid
CAHHA08055GMedicaid