Healthcare Provider Details

I. General information

NPI: 1144958257
Provider Name (Legal Business Name): CARE COORDINATOR AGENCY OF CA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2022
Last Update Date: 04/21/2023
Certification Date: 04/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15760 VENTURA BLVD STE 2030
ENCINO CA
91436-3067
US

IV. Provider business mailing address

15760 VENTURA BLVD STE 2030
ENCINO CA
91436-3067
US

V. Phone/Fax

Practice location:
  • Phone: 818-554-4769
  • Fax: 909-257-8981
Mailing address:
  • Phone: 818-554-4769
  • Fax: 909-257-8981

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: GEYANEH VARTANIAN
Title or Position: CEO
Credential:
Phone: 818-554-4769