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General NPI Number Information
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NPI Number | 1548878317
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Entity Type | Organization
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Legal Business Name | PROVISION HOME HEALTHCARE
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Dates
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Enumeration Date | 07/17/2020
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Last Update Date | 03/24/2025
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Provider Practice Location Address
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Address Line | 16600 SHERMAN WAY STE 205
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City | VAN NUYS
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State | CA
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Zip | 91406-3794
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Country | US
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Telephone | 747-320-7574
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Fax |
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Provider Business Mailing Address
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Address Line | 16600 SHERMAN WAY STE 205
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City | VAN NUYS
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State | CA
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Zip | 91406-3794
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Country | US
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Telephone | 747-320-7574
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Fax | 213-403-5392
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Authorized Official
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Title or Position | CEO
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Name | JUNIE SHAKHVALADYAN
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Credential |
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Telephone | 661-383-3477
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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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