MEDICARE: AVIA HOME HEALTHCARE 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	:	1285990606
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AVIA HOME HEALTHCARE INC.

Provider Business Mailing Address
First Line	:	2139 TAPO ST STE 204
Second Line	:
City	:	SIMI VALLEY
State	:	CA
Zip	:	93063-3476
Country	:	US
Telephone Number	:	805-459-4730
Fax Number	:	888-453-0513

Provider Business Practice Location Address
First Line	:	2139 TAPO ST STE 204
Second Line	:
City	:	SIMI VALLEY
State	:	CA
Zip	:	93063-3476
Country	:	US
Telephone Number	:	805-459-4730
Fax Number	:	888-453-0513

Authorized Official
Title or Position	:	CEO
Name	:	MRS. SEDA KOSHKARYAN
Credential	:
Telephone Number	:	805-459-4730

Provider Enumeration Date	:	04/10/2012
Last Update Date	:	04/10/2012

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