Healthcare Provider Details

I. General information

NPI: 1811591449
Provider Name (Legal Business Name): TRG HOME HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2020
Last Update Date: 11/24/2020
Certification Date: 11/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7034 VAN NUYS BLVD STE 204
VAN NUYS CA
91405-3060
US

IV. Provider business mailing address

7034 VAN NUYS BLVD STE 204
VAN NUYS CA
91405-3060
US

V. Phone/Fax

Practice location:
  • Phone: 818-796-4745
  • Fax:
Mailing address:
  • Phone: 818-796-4745
  • Fax:

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: TIGRAN VASILYAN
Title or Position: CEO
Credential:
Phone: 818-796-4745