MEDICARE: GARDENIA 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	251G00000X	Community Based Hospice Care Agency

General Provider Information

NPI Number	:	1851068381
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GARDENIA HOME HEALTH, INC.

Provider Business Mailing Address
First Line	:	435 ORANGE SHOW LN STE 102
Second Line	:
City	:	SAN BERNARDINO
State	:	CA
Zip	:	92408-2015
Country	:	US
Telephone Number	:	909-686-1720
Fax Number	:

Provider Business Practice Location Address
First Line	:	435 ORANGE SHOW LN STE 102
Second Line	:
City	:	SAN BERNARDINO
State	:	CA
Zip	:	92408-2015
Country	:	US
Telephone Number	:	909-686-1720
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	ALINA GEVORGYAN
Credential	:
Telephone Number	:	909-686-1720

Provider Enumeration Date	:	08/24/2021
Last Update Date	:	08/24/2021

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