Provider Demographics
NPI:1346089752
Name:MICHELLE PULLUM
Entity type:Organization
Organization Name:MICHELLE PULLUM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:PULLUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-909-6513
Mailing Address - Street 1:1200 W 85TH ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90044-2218
Mailing Address - Country:US
Mailing Address - Phone:310-909-6513
Mailing Address - Fax:
Practice Address - Street 1:1200 W 85TH ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90044-2218
Practice Address - Country:US
Practice Address - Phone:310-909-6513
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAFEGUARD RESIDENTIAL HOME
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-05-23
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health