Provider Demographics
NPI:1871735670
Name:EKPELE NURSING & STAFFING PROVIDER INC.
Entity type:Organization
Organization Name:EKPELE NURSING & STAFFING PROVIDER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/CFO
Authorized Official - Prefix:
Authorized Official - First Name:HUMPHREY
Authorized Official - Middle Name:AWANZIA
Authorized Official - Last Name:NEZIANYA
Authorized Official - Suffix:
Authorized Official - Credentials:BSHS/CNA
Authorized Official - Phone:323-226-9091
Mailing Address - Street 1:1550 STADIUM WAY
Mailing Address - Street 2:UNIT 5
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90012-1174
Mailing Address - Country:US
Mailing Address - Phone:323-226-9091
Mailing Address - Fax:323-223-2095
Practice Address - Street 1:1550 STADIUM WAY
Practice Address - Street 2:UNIT 5
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90012-1174
Practice Address - Country:US
Practice Address - Phone:323-226-9091
Practice Address - Fax:323-223-2095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-25
Last Update Date:2009-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3158591251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health