MEDICARE: MONGLEN HOME 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

General Provider Information

NPI Number	:	1396415220
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MONGLEN HOME CARE

Provider Business Mailing Address
First Line	:	1545 N VERDUGO RD STE 105
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91208-2861
Country	:	US
Telephone Number	:	747-977-1022
Fax Number	:	747-221-3977

Provider Business Practice Location Address
First Line	:	1545 N VERDUGO RD STE 105
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91208-2861
Country	:	US
Telephone Number	:	818-396-9321
Fax Number	:	707-737-5172

Authorized Official
Title or Position	:	CEO
Name	:	GAGIK SMBATYAN
Credential	:
Telephone Number	:	747-977-1022

Provider Enumeration Date	:	09/13/2021
Last Update Date	:	03/03/2026

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