Provider Demographics
NPI:1992751382
Name:ACCENTCARE HOME HEALTH OF CALIFORNIA, INC.
Entity type:Organization
Organization Name:ACCENTCARE HOME HEALTH OF CALIFORNIA, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP LEGAL
Authorized Official - Prefix:
Authorized Official - First Name:M'LISS
Authorized Official - Middle Name:JONES
Authorized Official - Last Name:KANE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-623-1582
Mailing Address - Street 1:17855 DALLAS PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75287-6852
Mailing Address - Country:US
Mailing Address - Phone:972-267-1100
Mailing Address - Fax:972-267-1116
Practice Address - Street 1:2590 GOODWATER AVE STE 100
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-1550
Practice Address - Country:US
Practice Address - Phone:530-223-3696
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2019-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA230000205251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA230000205OtherDEPARTMENT OF PUBLIC HEALTH
CAHHA57273FOtherMEDI-CAL
CAHHA57273FOtherMEDI-CAL