MEDICARE: OUR LADY OF REFUGE HOME CARE INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency		CA

General Provider Information

NPI Number	:	1023068319
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OUR LADY OF REFUGE HOME CARE INC

Provider Business Mailing Address
First Line	:	4000 W MAGNOLIA BLVD
Second Line	:	SUITE K
City	:	BURBANK
State	:	CA
Zip	:	91505-2827
Country	:	US
Telephone Number	:	818-558-7400
Fax Number	:	818-558-7407

Provider Business Practice Location Address
First Line	:	4000 W MAGNOLIA BLVD
Second Line	:	SUITE K
City	:	BURBANK
State	:	CA
Zip	:	91505-2827
Country	:	US
Telephone Number	:	818-558-7400
Fax Number	:	818-558-7407

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. MADLEN DAVTIAN
Credential	:
Telephone Number	:	818-618-8118

Provider Enumeration Date	:	05/10/2006
Last Update Date	:	12/13/2007

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