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General NPI Number Information
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NPI Number | 1669657821
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Entity Type | Organization
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Legal Business Name | HEAVENLY HOME HEALTH CARE, INC.
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Dates
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Enumeration Date | 01/07/2008
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Last Update Date | 11/14/2018
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Provider Practice Location Address
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Address Line | 3200 W BURBANK BLVD STE 100
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City | BURBANK
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State | CA
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Zip | 91505-2201
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Country | US
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Telephone | 323-662-7071
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Fax | 323-662-0189
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Provider Business Mailing Address
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Address Line | 4430 SANTA MONICA BLVD SUITE 201
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City | LOS ANGELES
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State | CA
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Zip | 90029-2014
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Country | US
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Telephone | 323-662-7071
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Fax | 323-662-0189
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Authorized Official
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Title or Position | CEO
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Name | VARTAN DERMENDJIAN
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Credential |
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Telephone | 323-662-7071
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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 | 550000279
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License Number State | CA
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