MEDICARE: ANGEL WINGS HOME HEALTH AGENCY

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	:	1306597323
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANGEL WINGS HOME HEALTH AGENCY

Provider Business Mailing Address
First Line	:	1443 N HIGHLAND AVE STE 1
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90028-7622
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1443 N HIGHLAND AVE STE 1
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90028-7622
Country	:	US
Telephone Number	:	818-422-4060
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	RUBEN MKHITARYAN
Credential	:
Telephone Number	:	818-422-4060

Provider Enumeration Date	:	01/11/2022
Last Update Date	:	01/11/2022

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