Provider Demographics
NPI:1952378812
Name:VIP HOME HEALTH CARE AGENCY
Entity Type:Organization
Organization Name:VIP HOME HEALTH CARE AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ANBE
Authorized Official - Middle Name:
Authorized Official - Last Name:BERHANE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-293-1339
Mailing Address - Street 1:1224 S GARFIELD AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801-5062
Mailing Address - Country:US
Mailing Address - Phone:626-293-1339
Mailing Address - Fax:626-293-1340
Practice Address - Street 1:1224 S GARFIELD AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91801-5062
Practice Address - Country:US
Practice Address - Phone:626-293-1339
Practice Address - Fax:626-293-1340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHHA57797FMedicaid
CA557797Medicare ID - Type Unspecified