MEDICARE: SEROV HOME HEALTH LLC

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	:	1770291296
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SEROV HOME HEALTH LLC

Provider Business Mailing Address
First Line	:	126 S JACKSON ST STE 200
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91205-4920
Country	:	US
Telephone Number	:	818-397-9025
Fax Number	:	818-937-9025

Provider Business Practice Location Address
First Line	:	126 S JACKSON ST STE 200
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91205-4920
Country	:	US
Telephone Number	:	818-397-9025
Fax Number	:	818-937-9025

Authorized Official
Title or Position	:	CEO
Name	:	ANNA KHACHIKYAN
Credential	:
Telephone Number	:	818-397-9025

Provider Enumeration Date	:	11/14/2022
Last Update Date	:	06/10/2024

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