MEDICARE: CAPRI 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		CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	058104	OTHER	CA	PROVIDER NUMBER

General Provider Information

NPI Number	:	1639176605
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAPRI HOME HEALTH AGENCY, INC.

Provider Business Mailing Address
First Line	:	5123 W SUNSET BLVD
Second Line	:	SUITE 201
City	:	LOS ANGELES
State	:	CA
Zip	:	90027-5779
Country	:	US
Telephone Number	:	323-644-8282
Fax Number	:	323-644-8838

Provider Business Practice Location Address
First Line	:	5123 W SUNSET BLVD
Second Line	:	SUITE 201
City	:	LOS ANGELES
State	:	CA
Zip	:	90027-5779
Country	:	US
Telephone Number	:	323-644-8282
Fax Number	:	323-644-8838

Authorized Official
Title or Position	:	PRESIDENT
Name	:	TEREZA BADROUMIAN
Credential	:
Telephone Number	:	323-644-8282

Provider Enumeration Date	:	07/05/2005
Last Update Date	:	08/22/2020

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