=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851763809
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PROSPECT HOME HEALTHCARE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/28/2015
-----------------------------------------------------
Last Update Date | 10/28/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7120 HAYVENHURST AVE SUITE 206
-----------------------------------------------------
City | VAN NUYS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91406-3843
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-849-5428
-----------------------------------------------------
Fax | 818-849-5837
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7120 HAYVENHURST AVE SUITE 206
-----------------------------------------------------
City | VAN NUYS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91406-3843
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-849-5428
-----------------------------------------------------
Fax | 818-849-5837
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/ADMINISTRATOR
-----------------------------------------------------
Name | FAITH OJO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 818-391-9180
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 980001111
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------