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Organization
PROFOUND HEALTH CARE
Active
Organization
PROFOUND HEALTH CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BENNIE NIBO (ADMINISTRATOR)
(323) 294-3559
Entity
Organization
Contact information
Practice address
4078 CRENSHAW BLVD, LOS ANGELES, CA 90008-2515
(323) 294-3559
(323) 294-3362
Mailing address
4078 CRENSHAW BLVD, LOS ANGELES, CA 90008-2515
(323) 294-3559
(323) 294-3362
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
HHA08024F
—
CA
Enumeration date
12/04/2006
Last updated
08/22/2020
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