MEDICARE: DEGA 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	:	1306519442
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEGA HOME HEALTH

Provider Business Mailing Address
First Line	:	6356 VAN NUYS BLVD STE 240
Second Line	:
City	:	VAN NUYS
State	:	CA
Zip	:	91401-2627
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6356 VAN NUYS BLVD STE 240
Second Line	:
City	:	VAN NUYS
State	:	CA
Zip	:	91401-2627
Country	:	US
Telephone Number	:	818-744-2474
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DARIA LIPATOVA
Credential	:
Telephone Number	:	818-744-2474

Provider Enumeration Date	:	07/26/2021
Last Update Date	:	07/26/2021

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Directions to “DEGA HOME HEALTH ” Practice Location

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