Healthcare Provider Details

I. General information

NPI: 1245779461
Provider Name (Legal Business Name): MED GROUP HOME HEALTH CARE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2017
Last Update Date: 02/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1633 ERRINGER RD SUITE 201A
SIMI VALLEY CA
93065-3583
US

IV. Provider business mailing address

1633 ERRINGER RD SUITE 201A
SIMI VALLEY CA
93065-3583
US

V. Phone/Fax

Practice location:
  • Phone: 805-210-5509
  • Fax: 805-210-5548
Mailing address:
  • Phone: 805-210-5509
  • Fax: 805-210-5548

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. EDGAR MELKUMYAN
Title or Position: PRESIDENT/CEO
Credential:
Phone: 805-210-5509