=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558852129
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HUMAN FIRST HOME HEALTH AGENCY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/19/2018
-----------------------------------------------------
Last Update Date | 04/22/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8345 RESEDA BLVD STE 208
-----------------------------------------------------
City | NORTHRIDGE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91324-5946
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-405-0473
-----------------------------------------------------
Fax | 818-405-0474
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8345 RESEDA BLVD STE 208
-----------------------------------------------------
City | NORTHRIDGE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91324-5946
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-405-0473
-----------------------------------------------------
Fax | 818-405-0474
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. PETER DANIEL PORCIUNCULA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 818-445-4544
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------