Healthcare Provider Details

I. General information

NPI: 1386443513
Provider Name (Legal Business Name): 2ND HOME ADULT HEALTH CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2025
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3225 FLETCHER DR
LOS ANGELES CA
90065-2919
US

IV. Provider business mailing address

17220 SUNBURST ST
SHERWOOD FOREST CA
91325-2923
US

V. Phone/Fax

Practice location:
  • Phone: 424-292-1212
  • Fax: 858-952-0509
Mailing address:
  • Phone: 818-926-0536
  • Fax: 858-952-0509

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SOFIA DJAVADIAN
Title or Position: CEO
Credential:
Phone: 818-926-0536