Provider Demographics
NPI:1639167208
Name:PRACTICARE HOME HEALTH AGENCY
Entity Type:Organization
Organization Name:PRACTICARE HOME HEALTH AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:ERICH
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-821-4880
Mailing Address - Street 1:223 NORTH FIRST AVE.
Mailing Address - Street 2:SUITE 103
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91006
Mailing Address - Country:US
Mailing Address - Phone:626-821-4880
Mailing Address - Fax:626-821-4477
Practice Address - Street 1:223 NORTH FIRST AVE.
Practice Address - Street 2:SUITE 103
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91006
Practice Address - Country:US
Practice Address - Phone:626-821-4880
Practice Address - Fax:626-821-4477
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-07
Last Update Date:2012-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA980000918251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHHA57550FMedicaid
CA557550Medicare ID - Type UnspecifiedMEDICARE