Healthcare Provider Details

I. General information

NPI: 1134875685
Provider Name (Legal Business Name): ST ANDY HOME HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2022
Last Update Date: 02/23/2022
Certification Date: 02/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14545 FRIAR ST STE 272
VAN NUYS CA
91411-2397
US

IV. Provider business mailing address

14545 FRIAR ST STE 272
VAN NUYS CA
91411-2397
US

V. Phone/Fax

Practice location:
  • Phone: 747-877-2006
  • Fax: 747-292-6814
Mailing address:
  • Phone: 747-877-2006
  • Fax: 747-292-6814

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: LAMARA SAKHIASHVILI
Title or Position: CEO,CFO,SECRETARY
Credential:
Phone: 747-877-2006