=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710445200
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CAMBRIDGE HHA LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/04/2019
-----------------------------------------------------
Last Update Date | 03/04/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 250 LOMBARD ST STE 7
-----------------------------------------------------
City | THOUSAND OAKS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91360-8213
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-831-0031
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 250 LOMBARD ST STE 7
-----------------------------------------------------
City | THOUSAND OAKS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91360-8213
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGING MEMBER
-----------------------------------------------------
Name | SRBUHI DURGHUTYAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 323-831-0031
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------