=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609535491
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | REAL CARE HOME HEALTH
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/09/2021
-----------------------------------------------------
Last Update Date | 12/09/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7335 VAN NUYS BLVD STE 107B
-----------------------------------------------------
City | VAN NUYS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91405-1951
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-787-1302
-----------------------------------------------------
Fax | 818-787-1308
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7335 VAN NUYS BLVD STE 107B
-----------------------------------------------------
City | VAN NUYS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91405-1951
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-787-1302
-----------------------------------------------------
Fax | 818-787-1308
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | HARRY GEVSHENIAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 818-787-1302
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------