MEDICARE: MMA HOME HEALTH CARE 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		CA

General Provider Information

NPI Number	:	1063926830
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MMA HOME HEALTH CARE INC

Provider Business Mailing Address
First Line	:	3800 W BURBANK BLVD STE 105
Second Line	:
City	:	BURBANK
State	:	CA
Zip	:	91505-2148
Country	:	US
Telephone Number	:	747-240-6100
Fax Number	:	747-240-6099

Provider Business Practice Location Address
First Line	:	3800 W BURBANK BLVD STE 105
Second Line	:
City	:	BURBANK
State	:	CA
Zip	:	91505-2148
Country	:	US
Telephone Number	:	747-240-6100
Fax Number	:	747-240-6099

Authorized Official
Title or Position	:	CEO
Name	:	MERRY AVETISYAN
Credential	:
Telephone Number	:	818-260-9975

Provider Enumeration Date	:	11/30/2017
Last Update Date	:	05/05/2022

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