Provider Demographics
NPI:1386603504
Name:USA HOME HEALTH, INC.
Entity type:Organization
Organization Name:USA HOME HEALTH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:BALUYOT
Authorized Official - Last Name:CARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:BS BA/NOTARY PUBLIC
Authorized Official - Phone:818-244-5112
Mailing Address - Street 1:1415 E COLORADO ST
Mailing Address - Street 2:SUITE 206
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91205-1533
Mailing Address - Country:US
Mailing Address - Phone:818-244-5112
Mailing Address - Fax:818-244-5422
Practice Address - Street 1:1415 E COLORADO ST
Practice Address - Street 2:SUITE 206
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91205-1533
Practice Address - Country:US
Practice Address - Phone:818-244-5112
Practice Address - Fax:818-244-5422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHHA07734HMedicaid
CAHD0197OtherREGIONAL CENTERS
CAHHA07734HMedicaid