Provider Demographics
NPI:1649263492
Name:CCAM, INC.
Entity type:Organization
Organization Name:CCAM, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:OMID
Authorized Official - Middle Name:
Authorized Official - Last Name:GABBAI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-641-4100
Mailing Address - Street 1:8929 S SEPULVEDA BLVD
Mailing Address - Street 2:#306
Mailing Address - City:WESTCHESTER
Mailing Address - State:CA
Mailing Address - Zip Code:90045-3616
Mailing Address - Country:US
Mailing Address - Phone:310-641-4100
Mailing Address - Fax:310-670-9944
Practice Address - Street 1:8929 S SEPULVEDA BLVD
Practice Address - Street 2:#306
Practice Address - City:WESTCHESTER
Practice Address - State:CA
Practice Address - Zip Code:90045-3616
Practice Address - Country:US
Practice Address - Phone:310-641-4100
Practice Address - Fax:310-670-9944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-26
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA980001124251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHHA08018FOtherMEDI-CAL ID #
CAHHA08018FOtherMEDI-CAL ID #