=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033432679
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SOCAL HOME HEALTH, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/10/2010
-----------------------------------------------------
Last Update Date | 05/05/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 225 E BROADWAY STE 202A
-----------------------------------------------------
City | GLENDALE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91205-1008
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-240-2227
-----------------------------------------------------
Fax | 818-240-4888
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 225 E BROADWAY STE 202A
-----------------------------------------------------
City | GLENDALE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91205-1008
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-240-2227
-----------------------------------------------------
Fax | 818-240-4888
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | ARMINE GEVORKIAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 818-240-2227
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 550001487
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------