Provider Demographics
NPI:1992799928
Name:ANNEX HEALTHCARE PROVIDERS INC
Entity type:Organization
Organization Name:ANNEX HEALTHCARE PROVIDERS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:FELOR
Authorized Official - Middle Name:
Authorized Official - Last Name:BAHADORI
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:818-509-2661
Mailing Address - Street 1:22041 CLARENDON ST STE 200
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367-6147
Mailing Address - Country:US
Mailing Address - Phone:818-884-8070
Mailing Address - Fax:818-484-3661
Practice Address - Street 1:22041 CLARENDON ST STE 200
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91367-6147
Practice Address - Country:US
Practice Address - Phone:818-884-8070
Practice Address - Fax:818-484-3661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-06
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA980001397251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHHA08180FMedicaid
CAHHA08180FMedicaid