Provider Demographics
NPI:1588655112
Name:XL CARE INC
Entity Type:Organization
Organization Name:XL CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:DMITRTIY
Authorized Official - Middle Name:
Authorized Official - Last Name:GRINBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-785-2944
Mailing Address - Street 1:20350 VENTURA BLVD STE 140
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-2484
Mailing Address - Country:US
Mailing Address - Phone:818-785-2944
Mailing Address - Fax:818-785-2956
Practice Address - Street 1:20350 VENTURA BLVD STE 140
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-2484
Practice Address - Country:US
Practice Address - Phone:818-785-2944
Practice Address - Fax:818-785-2956
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-02
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA980001478251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHHA08236FMedicaid
CA980001478OtherHOME HEALTH AGENCY LICENS
CAHH980002368OtherSTATE FACILITY ID
CAHH980002368OtherSTATE FACILITY ID