MEDICARE: LOYAL 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		CA

General Provider Information

NPI Number	:	1720228018
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOYAL HOME HEALTH CARE, INC.

Provider Business Mailing Address
First Line	:	2139 TAPO ST STE 208
Second Line	:
City	:	SIMI VALLEY
State	:	CA
Zip	:	93063-3476
Country	:	US
Telephone Number	:	805-583-1233
Fax Number	:

Provider Business Practice Location Address
First Line	:	2139 TAPO ST STE 208
Second Line	:
City	:	SIMI VALLEY
State	:	CA
Zip	:	93063-3476
Country	:	US
Telephone Number	:	805-583-1233
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MS. NELLY TADEVOSYAN
Credential	:
Telephone Number	:	805-583-1233

Provider Enumeration Date	:	02/25/2009
Last Update Date	:	10/03/2012

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