Healthcare Provider Details

I. General information

NPI: 1154069110
Provider Name (Legal Business Name): LIFELINE HOME HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2022
Last Update Date: 06/06/2022
Certification Date: 06/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18570 SHERMAN WAY STE K
RESEDA CA
91335-4140
US

IV. Provider business mailing address

18570 SHERMAN WAY STE K
RESEDA CA
91335-4140
US

V. Phone/Fax

Practice location:
  • Phone: 818-275-4404
  • Fax: 818-275-4404
Mailing address:
  • Phone: 818-275-4404
  • Fax: 818-275-4404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MS. ARPINE AVETISYAN
Title or Position: CEO
Credential:
Phone: 818-275-4404