MEDICARE: SOCAL HOME HEALTH SERVICES, 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	:	1316667363
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOCAL HOME HEALTH SERVICES, INC.

Provider Business Mailing Address
First Line	:	758 E COLORADO BLVD STE 205
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91101-2128
Country	:	US
Telephone Number	:	818-452-0425
Fax Number	:	818-452-0425

Provider Business Practice Location Address
First Line	:	758 E COLORADO BLVD STE 205
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91101-2128
Country	:	US
Telephone Number	:	818-452-0425
Fax Number	:	818-452-0425

Authorized Official
Title or Position	:	CEO
Name	:	MR. HAYK AYUNTS
Credential	:
Telephone Number	:	818-452-0425

Provider Enumeration Date	:	08/30/2022
Last Update Date	:	08/30/2022

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