Healthcare Provider Details

I. General information

NPI: 1134714017
Provider Name (Legal Business Name): PRIME PRO HOME HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2021
Last Update Date: 09/14/2023
Certification Date: 09/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 S BRAND BLVD STE 209
GLENDALE CA
91204-1372
US

IV. Provider business mailing address

127 S BRAND BLVD STE 209
GLENDALE CA
91204-1372
US

V. Phone/Fax

Practice location:
  • Phone: 818-369-1181
  • Fax:
Mailing address:
  • Phone: 818-369-1181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: ASHOT TSAGHKLORYAN
Title or Position: CEO/CFO/OWNER
Credential:
Phone: 818-369-1181