Healthcare Provider Details

I. General information

NPI: 1134835002
Provider Name (Legal Business Name): PHANTOM HOME HEALTH INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2023
Last Update Date: 01/25/2023
Certification Date: 01/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3531 N VERDUGO RD
GLENDALE CA
91208-1240
US

IV. Provider business mailing address

3531 N VERDUGO RD
GLENDALE CA
91208-1240
US

V. Phone/Fax

Practice location:
  • Phone: 818-330-9201
  • Fax: 818-330-9221
Mailing address:
  • Phone: 818-330-9201
  • Fax: 818-330-9221

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: ALISA NAZARYAN
Title or Position: CEO
Credential:
Phone: 818-330-9201