Healthcare Provider Details

I. General information

NPI: 1780129205
Provider Name (Legal Business Name): WHITE DOVES HOME CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2016
Last Update Date: 12/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

390 FULTON ST
CAMARILLO CA
93010-6545
US

IV. Provider business mailing address

390 FULTON ST
CAMARILLO CA
93010-6545
US

V. Phone/Fax

Practice location:
  • Phone: 818-650-0006
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: ERIC OVASAPYAN
Title or Position: MANAGING MEMBER
Credential:
Phone: 818-605-0006