Healthcare Provider Details

I. General information

NPI: 1659031813
Provider Name (Legal Business Name): PROUD TO SERVE HOME HEALTH CARE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2021
Last Update Date: 12/28/2021
Certification Date: 12/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14401 GILMORE ST # 201A
VAN NUYS CA
91401-6231
US

IV. Provider business mailing address

14401 GILMORE ST # 201A
VAN NUYS CA
91401-6231
US

V. Phone/Fax

Practice location:
  • Phone: 818-646-0273
  • Fax: 818-646-0274
Mailing address:
  • Phone: 818-646-0273
  • Fax: 818-646-0274

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. YELENA MURADYAN
Title or Position: CEO
Credential:
Phone: 818-646-0273