Provider Demographics
NPI:1659365948
Name:EXCELLENT IN-HOME CARE INC
Entity Type:Organization
Organization Name:EXCELLENT IN-HOME CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KHOSROW
Authorized Official - Middle Name:
Authorized Official - Last Name:ASSADI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-755-4900
Mailing Address - Street 1:16601 VENTURA BLVD
Mailing Address - Street 2:#506
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-1921
Mailing Address - Country:US
Mailing Address - Phone:818-755-4900
Mailing Address - Fax:818-654-0336
Practice Address - Street 1:16601 VENTURA BLVD
Practice Address - Street 2:#506
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-1921
Practice Address - Country:US
Practice Address - Phone:818-755-4900
Practice Address - Fax:818-654-0336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-01
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA980001145251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHHA08000FMedicaid
CAHHA08000FMedicaid