Provider Demographics
NPI:1154978633
Name:ANDALISIA HEALTHCARE INC.
Entity type:Organization
Organization Name:ANDALISIA HEALTHCARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MS
Authorized Official - First Name:SHERA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-246-0059
Mailing Address - Street 1:9135 W OLYMPIC BLVD
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212-3539
Mailing Address - Country:US
Mailing Address - Phone:310-246-0035
Mailing Address - Fax:
Practice Address - Street 1:9135 W OLYMPIC BLVD
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-3539
Practice Address - Country:US
Practice Address - Phone:310-246-0035
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-20
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1336308451OtherACUPUNCTURE
CA1225335086OtherACUOUNCTURE
CA1144487190OtherPHYSICAL THERAPY
CA1326449075OtherCHIROPRACTOR