Provider Demographics
NPI:1669522777
Name:UNITED CARE HOME HEALTHCARE AGENCY, INC.
Entity type:Organization
Organization Name:UNITED CARE HOME HEALTHCARE AGENCY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF NURSING PATIENT CARE SE
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:KORCHINSKAYA
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED NURSE
Authorized Official - Phone:818-892-3010
Mailing Address - Street 1:16921 PARTHENIA STREET
Mailing Address - Street 2:SUITE 303A
Mailing Address - City:NORTH HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91343-4559
Mailing Address - Country:US
Mailing Address - Phone:818-892-3040
Mailing Address - Fax:818-892-3044
Practice Address - Street 1:16921 PARTHENIA STREET
Practice Address - Street 2:SUITE 303A
Practice Address - City:NORTH HILLS
Practice Address - State:CA
Practice Address - Zip Code:91343-4559
Practice Address - Country:US
Practice Address - Phone:818-892-3040
Practice Address - Fax:818-892-3044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2011-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA550000214251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA550000214OtherLICENSE NUMBER
CA058375OtherMEDICARE PROVIDER NUMBER
CA058375OtherMEDICARE PROVIDER NUMBER