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General NPI Number Information
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NPI Number | 1336889344
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Entity Type | Organization
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Legal Business Name | PRO-SERVICE HOME HEALTH
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Dates
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Enumeration Date | 03/29/2022
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Last Update Date | 03/29/2022
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Provider Practice Location Address
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Address Line | 10235 SEPULVEDA BLVD STE B
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City | MISSION HILLS
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State | CA
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Zip | 91345-2639
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Country | US
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Telephone | 818-683-2403
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Fax | 818-683-2404
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Provider Business Mailing Address
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Address Line | 10235 SEPULVEDA BLVD STE B
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City | MISSION HILLS
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State | CA
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Zip | 91345-2639
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Country | US
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Telephone | 818-683-2403
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Fax | 818-683-2404
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Authorized Official
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Title or Position | CEO
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Name | LILIT SHADAREEVIAN
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Credential |
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Telephone | 818-683-2403
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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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