Healthcare Provider Details

I. General information

NPI: 1386390516
Provider Name (Legal Business Name): DEVINE HEALTH SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2022
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13746 VICTORY BLVD STE 207
VAN NUYS CA
91401-6718
US

IV. Provider business mailing address

13746 VICTORY BLVD STE 207
VAN NUYS CA
91401-6718
US

V. Phone/Fax

Practice location:
  • Phone: 213-374-3700
  • Fax: 213-374-3700
Mailing address:
  • Phone: 213-374-3700
  • Fax: 213-374-3700

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: GERASIM OHANYAN
Title or Position: CEO, CFO, SECRETARY
Credential:
Phone: 213-374-3700