Provider Demographics
NPI:1194749549
Name:HOME RELATED SERVICES INC
Entity type:Organization
Organization Name:HOME RELATED SERVICES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SERAFIN
Authorized Official - Middle Name:MONTEALTO
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-242-7552
Mailing Address - Street 1:914 N GLENDALE AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91206-2129
Mailing Address - Country:US
Mailing Address - Phone:818-242-7552
Mailing Address - Fax:818-241-0248
Practice Address - Street 1:914 N GLENDALE AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91206-2129
Practice Address - Country:US
Practice Address - Phone:818-242-7552
Practice Address - Fax:818-241-0248
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2012-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAR059970261QR0208X
261QR0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAXR0599700Medicaid
CAR059970Medicare UPIN