MEDICARE: GREEN PATH HOME HEALTH

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

General Provider Information

NPI Number	:	1063079010
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREEN PATH HOME HEALTH

Provider Business Mailing Address
First Line	:	12158 HAMLIN ST STE 2
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91606-1433
Country	:	US
Telephone Number	:	818-331-1913
Fax Number	:

Provider Business Practice Location Address
First Line	:	12158 HAMLIN ST STE 2
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91606-1433
Country	:	US
Telephone Number	:	818-331-1913
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MR. ALEN KESHISHYAN
Credential	:
Telephone Number	:	818-331-1913

Provider Enumeration Date	:	05/24/2019
Last Update Date	:	05/24/2019

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Directions to “GREEN PATH HOME HEALTH ” Practice Location

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