Provider Demographics
NPI:1770669236
Name:AMERICAN HEALTH SERVICES OF SAN DIEGO, LP
Entity Type:Organization
Organization Name:AMERICAN HEALTH SERVICES OF SAN DIEGO, LP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:
Authorized Official - Last Name:KAUFFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-556-0040
Mailing Address - Street 1:2535 CAMINO DEL RIO S.
Mailing Address - Street 2:SUITE 112
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-3755
Mailing Address - Country:US
Mailing Address - Phone:619-220-6980
Mailing Address - Fax:619-220-6981
Practice Address - Street 1:2535 CAMINO DEL RIO S.
Practice Address - Street 2:SUITE 112
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3755
Practice Address - Country:US
Practice Address - Phone:619-220-6980
Practice Address - Fax:619-220-6981
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA080000771251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA080000771OtherHOME HEALTH AGENCY LICENS
CA058345Medicare Oscar/Certification