MEDICARE: VITA LINE HOME HEALTH, 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	:	1982442737
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VITA LINE HOME HEALTH, INC

Provider Business Mailing Address
First Line	:	14531 HAMLIN ST STE 101
Second Line	:
City	:	VAN NUYS
State	:	CA
Zip	:	91411-4140
Country	:	US
Telephone Number	:	747-264-1022
Fax Number	:

Provider Business Practice Location Address
First Line	:	14531 HAMLIN ST STE 101
Second Line	:
City	:	VAN NUYS
State	:	CA
Zip	:	91411-4140
Country	:	US
Telephone Number	:	747-264-1022
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	KRISTINE SAHAKYAN
Credential	:
Telephone Number	:	747-264-1022

Provider Enumeration Date	:	07/16/2024
Last Update Date	:	07/16/2024

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