Provider Demographics
NPI:1962688374
Name:WESTSIDE HOME HEALTH, INC.
Entity Type:Organization
Organization Name:WESTSIDE HOME HEALTH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAIZY
Authorized Official - Middle Name:
Authorized Official - Last Name:KOREN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-644-9814
Mailing Address - Street 1:3171 LOS FELIZ BLVD
Mailing Address - Street 2:SUITE 212A
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90039-1527
Mailing Address - Country:US
Mailing Address - Phone:323-644-9814
Mailing Address - Fax:323-644-9822
Practice Address - Street 1:3171 LOS FELIZ BLVD
Practice Address - Street 2:SUITE 212A
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90039-1527
Practice Address - Country:US
Practice Address - Phone:323-644-9814
Practice Address - Fax:323-644-9822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-15
Last Update Date:2015-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA550000396251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA058398Medicare Oscar/Certification