Provider Demographics
NPI:1861503161
Name:CHARITY HOME HEALTH SERVICES
Entity Type:Organization
Organization Name:CHARITY HOME HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TOBENNA
Authorized Official - Middle Name:
Authorized Official - Last Name:ONWUNYI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-527-4339
Mailing Address - Street 1:500 E CARSON PLAZA DR
Mailing Address - Street 2:#228
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90746-3225
Mailing Address - Country:US
Mailing Address - Phone:310-527-4339
Mailing Address - Fax:
Practice Address - Street 1:500 E CARSON PLAZA DR
Practice Address - Street 2:#228
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90746-3225
Practice Address - Country:US
Practice Address - Phone:310-527-4339
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA980001063251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHHA57799FMedicare ID - Type UnspecifiedMEDI-CAL PROVIDER #
CA557799Medicare ID - Type UnspecifiedPROVIDER NUMBER