MEDICARE: DELTA HOME HEALTH AGENCY, INCORPORATED

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	:	1215121918
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DELTA HOME HEALTH AGENCY, INCORPORATED

Provider Business Mailing Address
First Line	:	2544 E WASHINGTON BLVD
Second Line	:	SUITE A
City	:	PASADENA
State	:	CA
Zip	:	91107-1452
Country	:	US
Telephone Number	:	626-296-0750
Fax Number	:	626-296-0572

Provider Business Practice Location Address
First Line	:	2544 E WASHINGTON BLVD
Second Line	:	SUITE A
City	:	PASADENA
State	:	CA
Zip	:	91107-1452
Country	:	US
Telephone Number	:	626-296-0750
Fax Number	:	626-296-0572

Authorized Official
Title or Position	:	CEO
Name	:	MR. JOHNNY AVAKIAN
Credential	:
Telephone Number	:	626-296-0750

Provider Enumeration Date	:	09/05/2007
Last Update Date	:	04/20/2008

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