Provider Demographics
NPI:1710590245
Name:INTERNATIONAL MEDICAL GROUP INC, HOME HEALTHCARE & HOSPICE
Entity Type:Organization
Organization Name:INTERNATIONAL MEDICAL GROUP INC, HOME HEALTHCARE & HOSPICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:VERA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-893-6632
Mailing Address - Street 1:14431 VENTURA BLVD STE 507
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91423-2606
Mailing Address - Country:US
Mailing Address - Phone:323-893-6632
Mailing Address - Fax:323-798-8770
Practice Address - Street 1:14431 VENTURA BLVD STE 507
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91423-2606
Practice Address - Country:US
Practice Address - Phone:323-893-6632
Practice Address - Fax:323-798-8770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-25
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251G00000XAgenciesHospice Care, Community Based
No163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Multi-Specialty
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Multi-Specialty
No251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No315D00000XNursing & Custodial Care FacilitiesHospice, Inpatient
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA8660OtherHHA