Healthcare Provider Details

I. General information

NPI: 1366528408
Provider Name (Legal Business Name): SUMMIT HOME HEALTH, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 05/21/2023
Certification Date: 05/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2139 TAPO ST STE. # 210
SIMI VALLEY CA
93063-3478
US

IV. Provider business mailing address

2139 TAPO ST STE. # 210
SIMI VALLEY CA
93063-3478
US

V. Phone/Fax

Practice location:
  • Phone: 805-584-3000
  • Fax: 805-584-3010
Mailing address:
  • Phone: 805-584-3000
  • Fax: 805-584-3010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number550000605
License Number StateCA

VIII. Authorized Official

Name: MR. KEON MARDANPOUR
Title or Position: OWNER / ADMINISTRATOR
Credential:
Phone: 805-584-3000