MEDICARE: 1ST CARE 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

General Provider Information

NPI Number	:	1154093417
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	1ST CARE HOME HEALTH CARE INC

Provider Business Mailing Address
First Line	:	1023 N HOLLYWOOD WAY STE 209
Second Line	:
City	:	BURBANK
State	:	CA
Zip	:	91505-2543
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1023 N HOLLYWOOD WAY STE 209
Second Line	:
City	:	BURBANK
State	:	CA
Zip	:	91505-2543
Country	:	US
Telephone Number	:	424-279-1027
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MS. ANNA INDZHYAN
Credential	:
Telephone Number	:	424-279-1027

Provider Enumeration Date	:	10/04/2021
Last Update Date	:	10/04/2021

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