Healthcare Provider Details

I. General information

NPI: 1861159774
Provider Name (Legal Business Name): GREEN ORCHID HOME HEALTH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/26/2021
Last Update Date: 03/28/2025
Certification Date: 03/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 E BROADWAY STE B117A
GLENDALE CA
91205-1008
US

IV. Provider business mailing address

225 E BROADWAY STE B117A
GLENDALE CA
91205-1008
US

V. Phone/Fax

Practice location:
  • Phone: 818-970-3914
  • Fax:
Mailing address:
  • Phone: 818-970-3914
  • 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: DIANA G SHATS
Title or Position: CEO/PRES.
Credential:
Phone: 626-464-2932