Basic Information
| Provider Information | |||||||||
| NPI: | 1417130865 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ASSOCIATED HEALTHCARE AGENCY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 27508 WALNUT SPRINGS AVE | ||||||||
| Address2: | |||||||||
| City: | CANYON COUNTRY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913512822 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6612992291 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4146 E OLYMPIC BLVD STE B | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900233347 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3232629948 | ||||||||
| FaxNumber: | 3232623708 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/07/2007 | ||||||||
| LastUpdateDate: | 12/07/2007 | ||||||||
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| AuthorizedOfficialLastName: | WASHINGTON | ||||||||
| AuthorizedOfficialFirstName: | GEORGE | ||||||||
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| AuthorizedOfficialTitleorPosition: | RESPIRATORY CARE PRACTITIONER | ||||||||
| AuthorizedOfficialTelephone: | 8182322875 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | JR. | ||||||||
| AuthorizedOfficialCredential: | RCP | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | 13861 | CA | Y | Agencies | Home Health |
No ID Information.