Provider Demographics
NPI:1366683096
Name:LVN/INHOME CARE NURSING
Entity type:Organization
Organization Name:LVN/INHOME CARE NURSING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF IN HOME CARE SERVICES
Authorized Official - Prefix:MR
Authorized Official - First Name:GASTON
Authorized Official - Middle Name:
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:866-508-2236
Mailing Address - Street 1:1 WORLD TRADE CTR
Mailing Address - Street 2:SUITE 800
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90831-0002
Mailing Address - Country:US
Mailing Address - Phone:866-508-2236
Mailing Address - Fax:619-330-2153
Practice Address - Street 1:1 WORLD TRADE CTR
Practice Address - Street 2:SUITE 800
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90831-0002
Practice Address - Country:US
Practice Address - Phone:866-508-2236
Practice Address - Fax:619-330-2153
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-09
Last Update Date:2009-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
No347C00000XTransportation ServicesPrivate Vehicle
No253Z00000XAgenciesIn Home Supportive Care
No252Y00000XAgenciesEarly Intervention Provider Agency
No251E00000XAgenciesHome Health