Healthcare Provider Details

I. General information

NPI: 1093414435
Provider Name (Legal Business Name): OPTION ONE HOME HEALTH CARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2023
Last Update Date: 07/16/2024
Certification Date: 07/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16218 MIL POTRERO HWY UNIT 201 STE A
PINE MOUNTAIN CLUB CA
93222
US

IV. Provider business mailing address

PO BOX 6841
PINE MOUNTAIN CLUB CA
93222-6841
US

V. Phone/Fax

Practice location:
  • Phone: 818-697-4481
  • Fax: 818-294-7119
Mailing address:
  • Phone: 818-697-4481
  • 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: LEVON VARDAPETYAN
Title or Position: CEO,CFO,OWNER,SECRETARY
Credential:
Phone: 818-697-4481