=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336618487
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SAM HOME HEALTH, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/19/2018
-----------------------------------------------------
Last Update Date | 08/23/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12444 VICTORY BLVD STE 302
-----------------------------------------------------
City | NORTH HOLLYWOOD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91606-3199
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-210-0337
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10545 BURBANK BLVD STE 108
-----------------------------------------------------
City | NORTH HOLLYWOOD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91601-2247
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | VERA AGOPIAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 818-210-0337
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------