Provider Demographics
NPI:1902007255
Name:CAPITAL HOME HEALTH AGENCY, INC.
Entity Type:Organization
Organization Name:CAPITAL HOME HEALTH AGENCY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDEN
Authorized Official - Middle Name:LELLIS
Authorized Official - Last Name:LOGAN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:310-253-5384
Mailing Address - Street 1:2818 LA CIENEGA AVE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90034-2618
Mailing Address - Country:US
Mailing Address - Phone:310-253-5384
Mailing Address - Fax:310-025-3919
Practice Address - Street 1:2818 LA CIENEGA AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90034-2618
Practice Address - Country:US
Practice Address - Phone:310-253-5384
Practice Address - Fax:310-253-9191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-31
Last Update Date:2007-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA980001281251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHHA08042FMedicaid
CA058042Medicare ID - Type UnspecifiedPROVIDER NUMBER