Healthcare Provider Details

I. General information

NPI: 1548839913
Provider Name (Legal Business Name): FAMILY CARE HOME HEALTH AGENCY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2021
Last Update Date: 06/22/2021
Certification Date: 06/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 N GLENOAKS BLVD STE 228
BURBANK CA
91502-1116
US

IV. Provider business mailing address

303 N GLENOAKS BLVD STE 228
BURBANK CA
91502-1116
US

V. Phone/Fax

Practice location:
  • Phone: 747-205-3021
  • Fax:
Mailing address:
  • Phone: 747-205-3021
  • 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: GYULNARA GRIGORYAN
Title or Position: CEO/OWNER
Credential:
Phone: 747-205-3021