Provider Demographics
NPI:1598377871
Name:360 CAREGIVERS HOME AGENCY LLC
Entity Type:Organization
Organization Name:360 CAREGIVERS HOME AGENCY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ARASH
Authorized Official - Middle Name:
Authorized Official - Last Name:SHARIFI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-519-4902
Mailing Address - Street 1:15870 CAMINO SAN BERNARDO APT 133
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92127-2367
Mailing Address - Country:US
Mailing Address - Phone:619-519-4902
Mailing Address - Fax:
Practice Address - Street 1:15870 CAMINO SAN BERNARDO APT 133
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92127-2367
Practice Address - Country:US
Practice Address - Phone:619-519-4902
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-19
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care