Provider Demographics
NPI:1205881778
Name:ASSISTED HOME CARE, INC
Entity type:Organization
Organization Name:ASSISTED HOME CARE, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DONLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-371-9988
Mailing Address - Street 1:72 MOODY COURT
Mailing Address - Street 2:SUITE 100
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-6067
Mailing Address - Country:US
Mailing Address - Phone:805-371-9988
Mailing Address - Fax:805-371-9987
Practice Address - Street 1:10550 SEPULVEDA BLVD STE 101
Practice Address - Street 2:
Practice Address - City:MISSION HILLS
Practice Address - State:CA
Practice Address - Zip Code:91345-1954
Practice Address - Country:US
Practice Address - Phone:818-830-5003
Practice Address - Fax:818-830-5019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHPCO1634GMedicaid
CA05-1634Medicare ID - Type Unspecified