Provider Demographics
NPI:1588020648
Name:ROTACARE OF GREATER LOS ANGELES
Entity Type:Organization
Organization Name:ROTACARE OF GREATER LOS ANGELES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MINA
Authorized Official - Middle Name:
Authorized Official - Last Name:MORTEZAI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:818-592-0055
Mailing Address - Street 1:6355 TOPANGA CANYON BLVD
Mailing Address - Street 2:SUITE 428
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367-2102
Mailing Address - Country:US
Mailing Address - Phone:877-829-5500
Mailing Address - Fax:
Practice Address - Street 1:6355 TOPANGA CANYON BLVD
Practice Address - Street 2:SUITE 428
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91367-2102
Practice Address - Country:US
Practice Address - Phone:877-829-5500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-05
Last Update Date:2016-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable