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General NPI Number Information
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NPI Number | 1063054849
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Entity Type | Organization
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Legal Business Name | LIFE HOME HEALTH SERVICES INC
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Dates
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Enumeration Date | 10/13/2019
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Last Update Date | 09/30/2022
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Provider Practice Location Address
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Address Line | 17337 VENTURA BLVD STE 304
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City | ENCINO
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State | CA
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Zip | 91316-4902
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Country | US
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Telephone | 747-233-1116
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Fax |
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Provider Business Mailing Address
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Address Line | 17337 VENTURA BLVD STE 304
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City | ENCINO
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State | CA
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Zip | 91316-4902
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Country | US
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Telephone | 747-233-1116
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | ALEXANDRE KOUCHAVCHILI
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Credential |
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Telephone | 747-233-6111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 364SH0200X
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Taxonomy Name | Home Health Clinical Nurse Specialist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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