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General NPI Number Information
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NPI Number | 1104220623
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Entity Type | Organization
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Legal Business Name | 360 HOME HEALTH AGENCY
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Dates
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Enumeration Date | 10/13/2014
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Last Update Date | 12/14/2014
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Provider Practice Location Address
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Address Line | 21133 VICTORY BLVD SUITE 206
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City | CANOGA PARK
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State | CA
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Zip | 91303-2829
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Country | US
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Telephone | 818-888-0100
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Fax |
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Provider Business Mailing Address
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Address Line | 20741 DOLOROSA ST
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City | WOODLAND HILLS
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State | CA
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Zip | 91367-6837
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Country | US
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Telephone | 818-888-0100
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | RAFAYEL NERSISYAN
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Credential | RN
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Telephone | 818-888-0100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 | CA
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