MEDICARE: LIFE HOME HEALTH SERVICES INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	364SH0200X	Home Health Clinical Nurse Specialist
2	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1063054849
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFE HOME HEALTH SERVICES INC

Provider Business Mailing Address
First Line	:	17337 VENTURA BLVD STE 304
Second Line	:
City	:	ENCINO
State	:	CA
Zip	:	91316-4902
Country	:	US
Telephone Number	:	747-233-1116
Fax Number	:

Provider Business Practice Location Address
First Line	:	17337 VENTURA BLVD STE 304
Second Line	:
City	:	ENCINO
State	:	CA
Zip	:	91316-4902
Country	:	US
Telephone Number	:	747-233-1116
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	ALEXANDRE KOUCHAVCHILI
Credential	:
Telephone Number	:	747-233-6111

Provider Enumeration Date	:	10/13/2019
Last Update Date	:	09/30/2022

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Directions to “LIFE HOME HEALTH SERVICES INC ” Practice Location

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