Healthcare Provider Details

I. General information

NPI: 1114182870
Provider Name (Legal Business Name): HEARTEN HOME HEALTH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2008
Last Update Date: 07/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1720 E LOS ANGELES AVE SUITE 217
SIMI VALLEY CA
93065-2057
US

IV. Provider business mailing address

1720 E LOS ANGELES AVE SUITE 217
SIMI VALLEY CA
93065-2057
US

V. Phone/Fax

Practice location:
  • Phone: 805-578-2327
  • Fax: 805-578-9327
Mailing address:
  • Phone: 805-578-2327
  • Fax: 805-578-9327

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number550000910
License Number StateCA

VIII. Authorized Official

Name: SAMUEL E ANUSIEM
Title or Position: CEO
Credential:
Phone: 805-578-2327