MEDICARE: A FAMILY FRIEND LLC

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	:	1225570476
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A FAMILY FRIEND LLC

Provider Business Mailing Address
First Line	:	26347 THOUSAND OAKS BLVD
Second Line	:	SUITE 169
City	:	CALABASAS
State	:	CA
Zip	:	91302-2644
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	625 N SYCAMORE AVE
Second Line	:	SUITE 117
City	:	LOS ANGELES
State	:	CA
Zip	:	90036-2054
Country	:	US
Telephone Number	:	818-533-8515
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DIANE WALLER
Credential	:
Telephone Number	:	818-533-8515

Provider Enumeration Date	:	11/04/2016
Last Update Date	:	11/04/2016

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