Healthcare Provider Details

I. General information

NPI: 1083836183
Provider Name (Legal Business Name): CELEBRITY HOMEHEALTH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 02/06/2024
Certification Date: 02/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2510 S RURAL RD STE 102
TEMPE AZ
85282-2497
US

IV. Provider business mailing address

14950 VENTURA BLVD
SHERMAN OAKS CA
91403-3455
US

V. Phone/Fax

Practice location:
  • Phone: 480-966-8888
  • Fax: 480-966-8892
Mailing address:
  • Phone: 818-343-4001
  • Fax: 818-996-4001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberAPPLIED FOR
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License NumberHSPC6509
License Number StateAZ

VIII. Authorized Official

Name: DAVID BUSTAN
Title or Position: CEO, PRES.
Credential: ACCOUNTANT
Phone: 818-492-1700