MEDICARE: WELLNESS WORKS HOME HEALTH, 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		CA

General Provider Information

NPI Number	:	1548573058
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WELLNESS WORKS HOME HEALTH, INC.

Provider Business Mailing Address
First Line	:	6400 LAUREL CANYON BLVD STE 640
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91606-1572
Country	:	US
Telephone Number	:	818-760-0501
Fax Number	:	818-763-3890

Provider Business Practice Location Address
First Line	:	6400 LAUREL CANYON BLVD STE 640
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91606-1572
Country	:	US
Telephone Number	:	818-760-0501
Fax Number	:	818-763-3890

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	RANDI PELED
Credential	:
Telephone Number	:	818-760-0501

Provider Enumeration Date	:	07/26/2010
Last Update Date	:	07/26/2010

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