Provider Demographics
NPI:1740503630
Name:COMPLETE CARE HOME HEALTH SERVICES, LLC
Entity type:Organization
Organization Name:COMPLETE CARE HOME HEALTH SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MAURICIO
Authorized Official - Middle Name:
Authorized Official - Last Name:RAYCO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:818-980-1641
Mailing Address - Street 1:6442 COLDWATER CANYON AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91606-1137
Mailing Address - Country:US
Mailing Address - Phone:818-980-1641
Mailing Address - Fax:818-980-1651
Practice Address - Street 1:6442 COLDWATER CANYON AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91606-1137
Practice Address - Country:US
Practice Address - Phone:818-980-1641
Practice Address - Fax:818-980-1651
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-05
Last Update Date:2010-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health