Provider Demographics
NPI:1821540840
Name:KG HOME CARE SERVICES LLC
Entity Type:Organization
Organization Name:KG HOME CARE SERVICES LLC
Other - Org Name:1HEART CAREGIVER SERVICES BEVERLY HILLS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:KAMRAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GHASRI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-456-8645
Mailing Address - Street 1:8383 WILSHIRE BLVD
Mailing Address - Street 2:STE 800
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-2425
Mailing Address - Country:US
Mailing Address - Phone:323-561-5658
Mailing Address - Fax:323-879-4282
Practice Address - Street 1:8383 WILSHIRE BLVD
Practice Address - Street 2:STE 800
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-2425
Practice Address - Country:US
Practice Address - Phone:323-561-5658
Practice Address - Fax:323-879-4282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-25
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA194700107251T00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization