Provider Demographics
NPI:1386862944
Name:LGA HOME HEALTH, INC.
Entity type:Organization
Organization Name:LGA HOME HEALTH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ROWENA
Authorized Official - Middle Name:
Authorized Official - Last Name:ELEGADO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-244-7626
Mailing Address - Street 1:1433 W MERCED AVE STE 324
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91790-3419
Mailing Address - Country:US
Mailing Address - Phone:818-244-7626
Mailing Address - Fax:818-245-1699
Practice Address - Street 1:1433 W MERCED AVE STE 324
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790-3419
Practice Address - Country:US
Practice Address - Phone:818-244-7626
Practice Address - Fax:818-245-1699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA550000836251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA059068Medicare Oscar/Certification