Healthcare Provider Details

I. General information

NPI: 1306502265
Provider Name (Legal Business Name): TRICARE HEALTHCARE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2021
Last Update Date: 09/13/2023
Certification Date: 09/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

639 S GLENWOOD PL STE 107B
BURBANK CA
91506-2819
US

IV. Provider business mailing address

639 S GLENWOOD PL # 102
BURBANK CA
91506-2819
US

V. Phone/Fax

Practice location:
  • Phone: 818-974-8998
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State

VIII. Authorized Official

Name: ANNA KARABOULOUTIAN
Title or Position: PRESIDENT
Credential:
Phone: 818-974-8998