MEDICARE: OLYMPIA 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	:	1598599458
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OLYMPIA HOME HEALTH INC

Provider Business Mailing Address
First Line	:	20422 BEACH BLVD STE 320
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92648-4377
Country	:	US
Telephone Number	:	657-377-0776
Fax Number	:	714-465-2233

Provider Business Practice Location Address
First Line	:	20422 BEACH BLVD STE 320
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92648-4377
Country	:	US
Telephone Number	:	675-254-5707
Fax Number	:	714-465-2233

Authorized Official
Title or Position	:	CEO
Name	:	JEONALYN ASHBY
Credential	:
Telephone Number	:	657-377-0776

Provider Enumeration Date	:	08/31/2024
Last Update Date	:	09/22/2024

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