Provider Demographics
NPI:1174992598
Name:CARSON HEALTHCARE SERVICES LLC
Entity type:Organization
Organization Name:CARSON HEALTHCARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHINWEIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:OGBODO
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:310-228-8682
Mailing Address - Street 1:17625 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90746-1661
Mailing Address - Country:US
Mailing Address - Phone:310-228-8682
Mailing Address - Fax:
Practice Address - Street 1:17625 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90746-1661
Practice Address - Country:US
Practice Address - Phone:310-228-8682
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-15
Last Update Date:2015-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251F00000X, 251J00000X, 253Z00000X
CA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251F00000XAgenciesHome Infusion
No251J00000XAgenciesNursing Care
No253Z00000XAgenciesIn Home Supportive Care