Provider Demographics
NPI:1215121074
Name:CITY OF ANGELS HOME HEALTH, INC.
Entity type:Organization
Organization Name:CITY OF ANGELS HOME HEALTH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:L
Authorized Official - Last Name:LAGLEVA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:310-303-7909
Mailing Address - Street 1:21707 HAWTHORNE BLVD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-7009
Mailing Address - Country:US
Mailing Address - Phone:310-303-7909
Mailing Address - Fax:310-303-7913
Practice Address - Street 1:21707 HAWTHORNE BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-7009
Practice Address - Country:US
Practice Address - Phone:310-303-7909
Practice Address - Fax:310-303-7913
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-04
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA550001255251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA059305OtherMEDICARE PROVIDER NUMBER
CA059305OtherMEDICARE PROVIDER NUMBER