MEDICARE: RUSH HOME HEALTH CARE, 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	:	1669254074
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RUSH HOME HEALTH CARE, INC.

Provider Business Mailing Address
First Line	:	11240 MAGNOLIA BLVD STE 101
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91601-3790
Country	:	US
Telephone Number	:	747-977-3593
Fax Number	:	747-977-3594

Provider Business Practice Location Address
First Line	:	11240 MAGNOLIA BLVD STE 101
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91601-3790
Country	:	US
Telephone Number	:	747-977-3593
Fax Number	:	747-977-3594

Authorized Official
Title or Position	:	CEO
Name	:	EDGAR GRIGORYAN
Credential	:
Telephone Number	:	747-977-3593

Provider Enumeration Date	:	10/19/2023
Last Update Date	:	10/19/2023

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