Healthcare Provider Details

I. General information

NPI: 1750968038
Provider Name (Legal Business Name): HOPE HAVEN HOME HEALTH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2021
Last Update Date: 03/24/2021
Certification Date: 03/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 BROADVIEW DR STE 261-Q
GLENDALE CA
91208-1259
US

IV. Provider business mailing address

1800 BROADVIEW DR STE 261-Q
GLENDALE CA
91208-1259
US

V. Phone/Fax

Practice location:
  • Phone: 747-297-2696
  • Fax: 747-297-2451
Mailing address:
  • Phone: 747-297-2696
  • Fax: 747-297-2451

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 Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State

VIII. Authorized Official

Name: RITA KHECHUMYAN
Title or Position: OWNER, CEO, CFO, SECRETARY
Credential:
Phone: 747-297-2696