Healthcare Provider Details

I. General information

NPI: 1972193753
Provider Name (Legal Business Name): HAVE FAITH HOME HEALTH SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2021
Last Update Date: 09/17/2021
Certification Date: 09/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 747-264-9473
  • 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
# 2
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State

VIII. Authorized Official

Name: HRIPSIME GOTTI
Title or Position: OWNER/CEO
Credential:
Phone: 747-264-9473