=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376011882
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MEDEX HOME HEALTH SERVICES, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/02/2018
-----------------------------------------------------
Last Update Date | 11/02/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 436 W COLORADO ST STE 113
-----------------------------------------------------
City | GLENDALE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91204-4567
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-484-7572
-----------------------------------------------------
Fax | 818-484-7573
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 436 W COLORADO ST STE 113
-----------------------------------------------------
City | GLENDALE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91204-4567
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-484-7572
-----------------------------------------------------
Fax | 818-484-7573
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CFO
-----------------------------------------------------
Name | EMIK BAZIKIAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 818-484-7572
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------