Provider Demographics
NPI:1700871233
Name:INTRA CARE HOME HEALTH PROVIDERS INC
Entity Type:Organization
Organization Name:INTRA CARE HOME HEALTH PROVIDERS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DIONALYN
Authorized Official - Middle Name:
Authorized Official - Last Name:UGBEBOR
Authorized Official - Suffix:
Authorized Official - Credentials:RN,BSN
Authorized Official - Phone:323-964-0884
Mailing Address - Street 1:4929 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90010-3808
Mailing Address - Country:US
Mailing Address - Phone:323-964-0884
Mailing Address - Fax:323-857-7206
Practice Address - Street 1:4929 WILSHIRE BLVD
Practice Address - Street 2:SUITE 210
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90010-3808
Practice Address - Country:US
Practice Address - Phone:323-964-0884
Practice Address - Fax:323-857-7206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-12
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA980001387251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA058135Medicare Oscar/Certification