Provider Demographics
NPI:1003662966
Name:MOBILE HOME HEALTH PALLIATIVE & HOSPICE MEDICAL GROUP
Entity type:Organization
Organization Name:MOBILE HOME HEALTH PALLIATIVE & HOSPICE MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:DAVIDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-212-1500
Mailing Address - Street 1:1270 S ALFRED ST UNIT 1064
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90035-2506
Mailing Address - Country:US
Mailing Address - Phone:310-212-1500
Mailing Address - Fax:
Practice Address - Street 1:1425 W MANCHESTER AVE STE A
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90047-5436
Practice Address - Country:US
Practice Address - Phone:310-212-1500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-30
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No251E00000XAgenciesHome HealthGroup - Multi-Specialty
No332900000XSuppliersNon-Pharmacy Dispensing Site
No332U00000XSuppliersHome Delivered Meals
No335G00000XSuppliersMedical Foods Supplier
No251F00000XAgenciesHome Infusion
No251G00000XAgenciesHospice Care, Community Based
No251J00000XAgenciesNursing Care
No251K00000XAgenciesPublic Health or Welfare
No251S00000XAgenciesCommunity/Behavioral Health
No253Z00000XAgenciesIn Home Supportive Care