Healthcare Provider Details

I. General information

NPI: 1750275285
Provider Name (Legal Business Name): TEL AVIV HOME HEALTH CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2025
Last Update Date: 06/09/2025
Certification Date: 06/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11633 VICTORY BLVD # 207B
NORTH HOLLYWOOD CA
91606-3513
US

IV. Provider business mailing address

11633 VICTORY BLVD # 207B
NORTH HOLLYWOOD CA
91606-3513
US

V. Phone/Fax

Practice location:
  • Phone: 850-888-8881
  • 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

VIII. Authorized Official

Name: VANUSH MIKAYELYAN
Title or Position: PRESIDENT/CEO
Credential:
Phone: 850-888-8881