Provider Demographics
NPI:1265553911
Name:OCEAN SIDE HOME HEALTH SERVICES,INC.
Entity type:Organization
Organization Name:OCEAN SIDE HOME HEALTH SERVICES,INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:TILAHUN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-934-5050
Mailing Address - Street 1:4322 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 208
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90010-3793
Mailing Address - Country:US
Mailing Address - Phone:323-934-5050
Mailing Address - Fax:323-934-9850
Practice Address - Street 1:4322 WILSHIRE BLVD
Practice Address - Street 2:SUITE 208
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90010-3793
Practice Address - Country:US
Practice Address - Phone:323-934-5050
Practice Address - Fax:323-934-9850
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OCEAN SIDE HOME HEALTH SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-02
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45465332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ092147OtherBLUE SHIELD
CA=========OtherWORKERS COMPENSATION
CA=========OtherBLUE CROSS
CAZZZ092147OtherBLUE SHIELD