Healthcare Provider Details

I. General information

NPI: 1891403689
Provider Name (Legal Business Name): FIFTH AVENUE HOME HEALTH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2022
Last Update Date: 11/09/2022
Certification Date: 11/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15826 VENTURA BLVD STE 222C
ENCINO CA
91436-2919
US

IV. Provider business mailing address

15826 VENTURA BLVD STE 222C
ENCINO CA
91436-2919
US

V. Phone/Fax

Practice location:
  • Phone: 818-281-5659
  • 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

VIII. Authorized Official

Name: ZARUI TER-POGOSYAN
Title or Position: CEO/CFO/SECRETARY
Credential:
Phone: 818-281-5659