MEDICARE: LANKERSHIM 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

General Provider Information

NPI Number	:	1164917290
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LANKERSHIM HOME CARE, INC.

Provider Business Mailing Address
First Line	:	6829 LANKERSHIM BLVD STE 207
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91605-6109
Country	:	US
Telephone Number	:	818-617-9656
Fax Number	:	818-698-8797

Provider Business Practice Location Address
First Line	:	6829 LANKERSHIM BLVD STE 207
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91605-6109
Country	:	US
Telephone Number	:	818-617-9656
Fax Number	:	818-698-8797

Authorized Official
Title or Position	:	CEO
Name	:	YURIK KARAPETYAN
Credential	:
Telephone Number	:	818-617-9656

Provider Enumeration Date	:	07/01/2018
Last Update Date	:	07/01/2018

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