Provider Demographics
NPI:1265586143
Name:HEALTHY LIVING AT HOME - LOS ANGELES, LLC.
Entity type:Organization
Organization Name:HEALTHY LIVING AT HOME - LOS ANGELES, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:BLISS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-658-2768
Mailing Address - Street 1:150 E OLIVE AVE STE 207
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91502-1850
Mailing Address - Country:US
Mailing Address - Phone:818-557-8310
Mailing Address - Fax:818-557-8356
Practice Address - Street 1:150 E OLIVE AVE STE 207
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91502-1850
Practice Address - Country:US
Practice Address - Phone:818-557-8310
Practice Address - Fax:818-557-8356
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2016-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA550000333251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA550000333OtherHOME HEALTH LICENSE
CA058474Medicare Oscar/Certification