=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184225203
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BURBANK CITY HOME HEALTH, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/04/2020
-----------------------------------------------------
Last Update Date | 11/04/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2000 W MAGNOLIA BLVD STE 205
-----------------------------------------------------
City | BURBANK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91506-1707
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 747-217-1712
-----------------------------------------------------
Fax | 747-283-2474
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2000 W MAGNOLIA BLVD STE 205
-----------------------------------------------------
City | BURBANK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91506-1707
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 747-217-1712
-----------------------------------------------------
Fax | 747-283-2474
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | ROUBEN VIRABOV
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 747-217-1712
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------