Provider Demographics
NPI:1912232620
Name:PRINCIPAL HOME HEALTH LLC
Entity Type:Organization
Organization Name:PRINCIPAL HOME HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:TRUNG-TAI
Authorized Official - Last Name:PHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:310-775-1763
Mailing Address - Street 1:1021 N. CRESCENT HEIGHTS BLVD #207
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90046
Mailing Address - Country:US
Mailing Address - Phone:310-775-1763
Mailing Address - Fax:
Practice Address - Street 1:1021 N. CRESCENT HEIGHTS BLVD #207
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90046
Practice Address - Country:US
Practice Address - Phone:310-775-1763
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-14
Last Update Date:2009-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health