Provider Demographics
NPI:1811076870
Name:DYNAMIC HOME CARE SERVICES INC.
Entity type:Organization
Organization Name:DYNAMIC HOME CARE SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/CFO
Authorized Official - Prefix:DR
Authorized Official - First Name:NISSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PARDO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:818-981-4446
Mailing Address - Street 1:14260 VENTURA BLVD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91423-2734
Mailing Address - Country:US
Mailing Address - Phone:818-981-4446
Mailing Address - Fax:818-981-0677
Practice Address - Street 1:14260 VENTURA BLVD
Practice Address - Street 2:SUITE 301
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91423-2734
Practice Address - Country:US
Practice Address - Phone:818-981-4446
Practice Address - Fax:818-981-0677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA980000668251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHHA57280FMedicaid
CA557280Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER