Provider Demographics
NPI:1669689048
Name:IDEAL HOME CARE
Entity type:Organization
Organization Name:IDEAL HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSEE
Authorized Official - Prefix:
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:
Authorized Official - Last Name:HARDIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-739-3585
Mailing Address - Street 1:4000 W 139TH ST
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:CA
Mailing Address - Zip Code:90250-7304
Mailing Address - Country:US
Mailing Address - Phone:310-739-3585
Mailing Address - Fax:310-377-9508
Practice Address - Street 1:4830 W 130TH ST
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250-5010
Practice Address - Country:US
Practice Address - Phone:310-973-8266
Practice Address - Fax:310-675-8760
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities