MEDICARE: FAST RECOVERY 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	:	1396498150
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAST RECOVERY HOME CARE INC

Provider Business Mailing Address
First Line	:	13749 VICTORY BLVD UNIT D
Second Line	:
City	:	VAN NUYS
State	:	CA
Zip	:	91401-2348
Country	:	US
Telephone Number	:	818-473-5352
Fax Number	:

Provider Business Practice Location Address
First Line	:	13749 VICTORY BLVD UNIT D
Second Line	:
City	:	VAN NUYS
State	:	CA
Zip	:	91401-2348
Country	:	US
Telephone Number	:	818-473-5352
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	VARDUI EKIMYAN
Credential	:
Telephone Number	:	818-473-5352

Provider Enumeration Date	:	02/01/2022
Last Update Date	:	02/01/2022

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