Provider Demographics
NPI:1891320685
Name:ULTRACARE SERVICES LLC
Entity Type:Organization
Organization Name:ULTRACARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LESLEE
Authorized Official - Middle Name:
Authorized Official - Last Name:DEANES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-266-9668
Mailing Address - Street 1:8549 WILSHIRE BLVD # 151
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-3104
Mailing Address - Country:US
Mailing Address - Phone:310-691-8161
Mailing Address - Fax:888-797-5605
Practice Address - Street 1:1117 W MANCHESTER BLVD STE B
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301-1588
Practice Address - Country:US
Practice Address - Phone:818-266-9668
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-11
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA194700273OtherSTATE LICENSE