MEDICARE: ANGEL OF MERCY HOME HEALTH CARE

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	550004502	OTHER	CA	CA LICENSE

General Provider Information

NPI Number	:	1306379383
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANGEL OF MERCY HOME HEALTH CARE

Provider Business Mailing Address
First Line	:	1110 SONORA AVE STE 102
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91201-3166
Country	:	US
Telephone Number	:	818-937-9440
Fax Number	:	818-937-9441

Provider Business Practice Location Address
First Line	:	1110 SONORA AVE STE 102
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91201-3166
Country	:	US
Telephone Number	:	818-937-9440
Fax Number	:	818-937-9441

Authorized Official
Title or Position	:	CEO
Name	:	MR. GRAND OGANESYAN
Credential	:
Telephone Number	:	818-937-9440

Provider Enumeration Date	:	04/06/2017
Last Update Date	:	03/12/2026

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Directions to “ANGEL OF MERCY HOME HEALTH CARE ” Practice Location

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