MEDICARE: HOLISTIC HOME HEALTH, 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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1063912020
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOLISTIC HOME HEALTH, INC.

Provider Business Mailing Address
First Line	:	3306 GLENDALE BLVD STE 7
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90039-1838
Country	:	US
Telephone Number	:	323-364-2356
Fax Number	:	323-364-6304

Provider Business Practice Location Address
First Line	:	3306 GLENDALE BLVD STE 7
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90039-1838
Country	:	US
Telephone Number	:	323-364-2356
Fax Number	:	323-364-6304

Authorized Official
Title or Position	:	CEO
Name	:	ARTHUR DERMENDJIAN
Credential	:
Telephone Number	:	323-364-2356

Provider Enumeration Date	:	02/16/2018
Last Update Date	:	02/16/2018

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