=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730899907
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NEWHALL GROUP HOME CARE INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/29/2022
-----------------------------------------------------
Last Update Date | 03/09/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 22938 LYONS AVE
-----------------------------------------------------
City | NEWHALL
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91321-2718
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 661-403-0504
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 22938 LYONS AVE
-----------------------------------------------------
City | NEWHALL
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91321-2718
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 661-403-0504
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | GAGIK DAVTIAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 661-403-0504
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------