MEDICARE: 360 HOME HEALTH

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	:	1194097576
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	360 HOME HEALTH

Provider Business Mailing Address
First Line	:	4430 SANTA MONICA BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90029-2014
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4430 SANTA MONICA BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90029-2014
Country	:	US
Telephone Number	:	323-899-5510
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	FRIDA ZAKARYAN
Credential	:
Telephone Number	:	323-899-5510

Provider Enumeration Date	:	02/01/2012
Last Update Date	:	02/01/2012

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