=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528265923
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HEALTHY LIFE HOME CARE, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/28/2007
-----------------------------------------------------
Last Update Date | 09/03/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 16661 VENTURA BLVD STE 613
-----------------------------------------------------
City | ENCINO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91436-1985
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-787-9950
-----------------------------------------------------
Fax | 818-787-9940
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 16661 VENTURA BLVD STE 613
-----------------------------------------------------
City | ENCINO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91436-1985
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-787-9950
-----------------------------------------------------
Fax | 818-787-9940
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MISS MINOO SEDEHIZADEH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 818-982-2600
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------