Provider Demographics
NPI:1770150708
Name:PALISADES HEALTHCARE SERVICES, LLC
Entity type:Organization
Organization Name:PALISADES HEALTHCARE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:TOMEKO
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON-SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MHA, EDD, PHD, PMP
Authorized Official - Phone:213-263-1442
Mailing Address - Street 1:1163 YORBA ST
Mailing Address - Street 2:
Mailing Address - City:PERRIS
Mailing Address - State:CA
Mailing Address - Zip Code:92571-7776
Mailing Address - Country:US
Mailing Address - Phone:213-263-1442
Mailing Address - Fax:
Practice Address - Street 1:1163 YORBA ST
Practice Address - Street 2:
Practice Address - City:PERRIS
Practice Address - State:CA
Practice Address - Zip Code:92571-7776
Practice Address - Country:US
Practice Address - Phone:213-263-1442
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PALISADES HEALTHCARE SERVICES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-06-08
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
No253Z00000XAgenciesIn Home Supportive Care
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)