MEDICARE: CORE HOME HEALTH AGENCY, 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

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	059443	OTHER		MEDICARE PROVIDER NUMBER

General Provider Information

NPI Number	:	1578886651
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CORE HOME HEALTH AGENCY, INC.

Provider Business Mailing Address
First Line	:	421 ARDEN AVE
Second Line	:	SUITE B
City	:	GLENDALE
State	:	CA
Zip	:	91203-4008
Country	:	US
Telephone Number	:	818-637-2673
Fax Number	:	818-484-2074

Provider Business Practice Location Address
First Line	:	421 ARDEN AVE
Second Line	:	SUITE B
City	:	GLENDALE
State	:	CA
Zip	:	91203-4008
Country	:	US
Telephone Number	:	818-637-2673
Fax Number	:	818-484-2074

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	GURAM MARGALITZADE
Credential	:
Telephone Number	:	818-637-2673

Provider Enumeration Date	:	03/03/2010
Last Update Date	:	06/23/2020

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