Provider Demographics
NPI:1104917426
Name:INTERCARE HEALTH SYSTEMS INC
Entity type:Organization
Organization Name:INTERCARE HEALTH SYSTEMS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:N
Authorized Official - Last Name:COWLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-989-6114
Mailing Address - Street 1:1711 WEST TEMPLE STREET
Mailing Address - Street 2:ATTN BUSINESS OFFICE
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90026-5421
Mailing Address - Country:US
Mailing Address - Phone:213-989-6100
Mailing Address - Fax:213-484-3552
Practice Address - Street 1:1711 WEST TEMPLE STREET
Practice Address - Street 2:ATTN BUSINESS OFFICE
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90026-5421
Practice Address - Country:US
Practice Address - Phone:213-989-6100
Practice Address - Fax:213-484-3552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA282N00000X, 283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered282N00000XHospitalsGeneral Acute Care Hospital
Not Answered283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHSC30725FMedicaid
CAHSC30725FMedicaid