=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184345035
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PROSHIELD HOME HEALTH SERVICES INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/08/2022
-----------------------------------------------------
Last Update Date | 09/08/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7316 DEERING AVE STE 201
-----------------------------------------------------
City | CANOGA PARK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91303-1503
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 213-776-3778
-----------------------------------------------------
Fax | 213-776-3779
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7316 DEERING AVE STE 201
-----------------------------------------------------
City | CANOGA PARK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91303-1503
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 213-776-3778
-----------------------------------------------------
Fax | 213-776-3779
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MARIAM TADEVOSYAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 220-777-7770
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------