MEDICARE: HEALTHY DESTINATIONS HEALTHCARE, 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	:	1891976056
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALTHY DESTINATIONS HEALTHCARE, INC.

Provider Business Mailing Address
First Line	:	3410 N SAN FERNANDO RD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90065-1442
Country	:	US
Telephone Number	:	323-369-1794
Fax Number	:

Provider Business Practice Location Address
First Line	:	3410 N SAN FERNANDO RD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90065-1442
Country	:	US
Telephone Number	:	323-369-1794
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	MR. ALBERTO CHUA
Credential	:
Telephone Number	:	323-369-1794

Provider Enumeration Date	:	11/16/2007
Last Update Date	:	11/16/2007

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