=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740933837
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CARISSA HOME HEALTH, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/30/2022
-----------------------------------------------------
Last Update Date | 01/30/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 18344 OXNARD ST STE 213
-----------------------------------------------------
City | TARZANA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91356-6781
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-835-0751
-----------------------------------------------------
Fax | 818-797-2887
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 18344 OXNARD ST STE 213
-----------------------------------------------------
City | TARZANA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91356-6781
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-835-0751
-----------------------------------------------------
Fax | 818-797-2887
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO/BOARD MEMBER
-----------------------------------------------------
Name | ANNA ARBOUET
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 818-835-0751
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------