Healthcare Provider Details

I. General information

NPI: 1902415086
Provider Name (Legal Business Name): ELTA HOME HEALTH CARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2020
Last Update Date: 07/24/2020
Certification Date: 07/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6454 VAN NUYS BLVD STE 6
VAN NUYS CA
91401-1445
US

IV. Provider business mailing address

6454 VAN NUYS BLVD STE 6
VAN NUYS CA
91401-1445
US

V. Phone/Fax

Practice location:
  • Phone: 818-756-2015
  • Fax:
Mailing address:
  • Phone: 818-756-2015
  • 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: NINUL TER-ANDRIASYANTS
Title or Position: CEO
Credential:
Phone: 818-756-2015