Healthcare Provider Details

I. General information

NPI: 1063054849
Provider Name (Legal Business Name): LIFE HOME HEALTH SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2019
Last Update Date: 09/30/2022
Certification Date: 09/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17337 VENTURA BLVD STE 304
ENCINO CA
91316-4902
US

IV. Provider business mailing address

17337 VENTURA BLVD STE 304
ENCINO CA
91316-4902
US

V. Phone/Fax

Practice location:
  • Phone: 747-233-1116
  • Fax:
Mailing address:
  • Phone: 747-233-1116
  • 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 Code364SH0200X
TaxonomyHome Health Clinical Nurse Specialist
License Number
License Number State

VIII. Authorized Official

Name: ALEXANDRE KOUCHAVCHILI
Title or Position: CEO
Credential:
Phone: 747-233-6111