=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063926830
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MMA HOME HEALTH CARE INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/30/2017
-----------------------------------------------------
Last Update Date | 05/05/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3800 W BURBANK BLVD STE 105
-----------------------------------------------------
City | BURBANK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91505-2148
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 747-240-6100
-----------------------------------------------------
Fax | 747-240-6099
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3800 W BURBANK BLVD STE 105
-----------------------------------------------------
City | BURBANK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91505-2148
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 747-240-6100
-----------------------------------------------------
Fax | 747-240-6099
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MERRY AVETISYAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 818-260-9975
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------