MEDICARE: VALLEY VILLAGE HOME CARE 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		CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1871007724
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VALLEY VILLAGE HOME CARE INC

Provider Business Mailing Address
First Line	:	5940 1/2 LAUREL CANYON BLVD
Second Line	:
City	:	VALLEY VILLAGE
State	:	CA
Zip	:	91607
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5940 1/2 LAUREL CANYON BLVD
Second Line	:
City	:	VALLEY VILLAGE
State	:	CA
Zip	:	91607
Country	:	US
Telephone Number	:	818-579-4763
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	ARTUR POGOSYAN
Credential	:
Telephone Number	:	818-579-4763

Provider Enumeration Date	:	11/29/2017
Last Update Date	:	12/27/2018

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