Healthcare Provider Details

I. General information

NPI: 1376256099
Provider Name (Legal Business Name): NEW CENTURY HOME HEALTH SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2022
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 203 STE A
PINE MOUNTAIN CLUB CA
93222
US

IV. Provider business mailing address

16218 MIL POTRERO HWY UNIT 203 STE A
PINE MOUNTAIN CLUB CA
93222
US

V. Phone/Fax

Practice location:
  • Phone: 818-697-6304
  • Fax: 818-649-3260
Mailing address:
  • Phone: 818-697-6304
  • Fax: 818-649-3260

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: SYUZANNA VARDAPETYAN
Title or Position: OWNER, CEO, CFO, SECRETARY
Credential:
Phone: 818-649-3290