MEDICARE: RENOVA 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

General Provider Information

NPI Number	:	1578494365
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RENOVA HOME HEALTH INC

Provider Business Mailing Address
First Line	:	15747 VENTURA BLVD
Second Line	:	STE 302
City	:	ENCINO
State	:	CA
Zip	:	91316
Country	:	US
Telephone Number	:	818-875-7044
Fax Number	:

Provider Business Practice Location Address
First Line	:	15747 VENTURA BLVD
Second Line	:	STE 302
City	:	ENCINO
State	:	CA
Zip	:	91316
Country	:	US
Telephone Number	:	818-875-7044
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	YEVGENIY INKS
Credential	:
Telephone Number	:	818-875-7044

Provider Enumeration Date	:	05/28/2026
Last Update Date	:	05/28/2026

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