Provider Demographics
NPI:1891133864
Name:LANTAN LLC
Entity Type:Organization
Organization Name:LANTAN LLC
Other - Org Name:AZUL HOME CARE PARTNERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:DANNY
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:LANTAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-862-9249
Mailing Address - Street 1:7625 ROSECRANS AVENUE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:PARAMOUNT
Mailing Address - State:CA
Mailing Address - Zip Code:90723-7382
Mailing Address - Country:US
Mailing Address - Phone:562-862-9249
Mailing Address - Fax:562-862-9247
Practice Address - Street 1:7625 ROSECRANS AVE STE 3
Practice Address - Street 2:
Practice Address - City:PARAMOUNT
Practice Address - State:CA
Practice Address - Zip Code:90723-7382
Practice Address - Country:US
Practice Address - Phone:562-862-9249
Practice Address - Fax:562-862-9247
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-12
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26510332B00000X
CA96782332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA3864Medicaid
CA4467OtherCENTRAL HEALTH PLAN
CA4467OtherCENTRAL HEALTH PLAN