Provider Demographics
NPI:1366448441
Name:MADISON HEALTHCARE, INC.
Entity type:Organization
Organization Name:MADISON HEALTHCARE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWIN
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:QUINN
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:562-799-1234
Mailing Address - Street 1:18720 OXNARD ST
Mailing Address - Street 2:STE 114
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-5943
Mailing Address - Country:US
Mailing Address - Phone:818-345-1111
Mailing Address - Fax:818-345-1385
Practice Address - Street 1:18720 OXNARD ST
Practice Address - Street 2:STE 114
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-5943
Practice Address - Country:US
Practice Address - Phone:818-345-1111
Practice Address - Fax:818-345-1385
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA980000782251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHHA57624HMedicaid