Healthcare Provider Details

I. General information

NPI: 1245954916
Provider Name (Legal Business Name): OPAL HOME HEALTH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2022
Last Update Date: 03/27/2023
Certification Date: 03/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5301 LAUREL CANYON BLVD # 237B
VALLEY VILLAGE CA
91607-2736
US

IV. Provider business mailing address

5301 LAUREL CANYON BLVD # 237B
VALLEY VILLAGE CA
91607-2736
US

V. Phone/Fax

Practice location:
  • Phone: 818-614-3332
  • Fax: 818-614-3332
Mailing address:
  • Phone: 818-614-3332
  • Fax: 818-614-3332

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: MS. ANUSH PETIKYAN
Title or Position: CEO
Credential:
Phone: 818-614-3332