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General NPI Number Information
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NPI Number | 1215406905
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Entity Type | Organization
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Legal Business Name | PROSPECT HOME HEALTHCARE, LLC
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Dates
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Enumeration Date | 11/25/2018
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Last Update Date | 02/04/2022
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Provider Practice Location Address
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Address Line | 7120 HAYVENHURST AVE STE 206
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City | VAN NUYS
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State | CA
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Zip | 91406-3813
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Country | US
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Telephone | 818-849-5428
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Fax | 818-849-5837
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Provider Business Mailing Address
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Address Line | 7120 HAYVENHURST AVE STE 206
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City | VAN NUYS
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State | CA
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Zip | 91406-3813
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Country | US
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Telephone | 818-849-5428
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Fax | 818-849-5837
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Authorized Official
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Title or Position | CEO/CFO
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Name | SHAMAM HARUTYUNYAN
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Credential |
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Telephone | 818-849-5428
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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 |
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