Provider Demographics
NPI:1982097358
Name:FIRST FAMILY TRUST HEALTHCARE SERVICES
Entity Type:Organization
Organization Name:FIRST FAMILY TRUST HEALTHCARE SERVICES
Other - Org Name:FIRST FAMILY TRUST SENIOR CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/C.E.O.
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:IKHIDE
Authorized Official - Last Name:IMOESIRI
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:818-629-8678
Mailing Address - Street 1:PO BOX 572362
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91357-2362
Mailing Address - Country:US
Mailing Address - Phone:818-629-8678
Mailing Address - Fax:
Practice Address - Street 1:18926 WYANDOTTE ST
Practice Address - Street 2:
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-2658
Practice Address - Country:US
Practice Address - Phone:818-578-6405
Practice Address - Fax:818-578-6405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-10
Last Update Date:2015-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA197608906251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health