MEDICARE: PRINCIPLE 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	:	1801403985
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRINCIPLE HOME HEALTH , INC.

Provider Business Mailing Address
First Line	:	9608 VAN NUYS BLVD STE 204B
Second Line	:
City	:	PANORAMA CITY
State	:	CA
Zip	:	91402-1043
Country	:	US
Telephone Number	:	818-830-0030
Fax Number	:	818-830-0307

Provider Business Practice Location Address
First Line	:	9608 VAN NUYS BLVD STE 204B
Second Line	:
City	:	PANORAMA CITY
State	:	CA
Zip	:	91402-1043
Country	:	US
Telephone Number	:	818-830-0030
Fax Number	:	818-830-0307

Authorized Official
Title or Position	:	CEO/PREDIDENT
Name	:	ANTON GORSKIKH
Credential	:
Telephone Number	:	818-830-0030

Provider Enumeration Date	:	09/23/2020
Last Update Date	:	09/23/2020

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Directions to “PRINCIPLE HOME HEALTH , INC. ” Practice Location

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