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General NPI Number Information
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NPI Number | 1972179067
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Entity Type | Organization
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Legal Business Name | MEDLINE HOME CARE
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Dates
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Enumeration Date | 05/31/2021
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Last Update Date | 05/31/2021
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Provider Practice Location Address
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Address Line | 1480 COLORADO BLVD STE 255A
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City | LOS ANGELES
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State | CA
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Zip | 90041-2357
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Country | US
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Telephone | 818-838-7314
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Fax | 818-839-5876
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Provider Business Mailing Address
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Address Line | 1480 COLORADO BLVD STE 255A
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City | LOS ANGELES
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State | CA
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Zip | 90041-2357
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Country | US
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Telephone | 818-838-7314
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Fax | 818-839-5876
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Authorized Official
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Title or Position | CEO
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Name | ASHKHEN ATOYAN
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Credential |
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Telephone | 818-838-7314
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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 |
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License Number State |
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