MEDICARE: BLUE PACIFIC HOME HEALTH

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	:	1972194165
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLUE PACIFIC HOME HEALTH

Provider Business Mailing Address
First Line	:	5658 SEPULVEDA BLVD STE 210
Second Line	:
City	:	VAN NUYS
State	:	CA
Zip	:	91411-2951
Country	:	US
Telephone Number	:	818-947-8787
Fax Number	:

Provider Business Practice Location Address
First Line	:	5658 SEPULVEDA BLVD STE 210
Second Line	:
City	:	VAN NUYS
State	:	CA
Zip	:	91411-2951
Country	:	US
Telephone Number	:	818-947-8787
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	SUZANNA HOVHANNISYAN
Credential	:
Telephone Number	:	818-947-8787

Provider Enumeration Date	:	01/29/2021
Last Update Date	:	01/29/2021

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Directions to “BLUE PACIFIC HOME HEALTH ” Practice Location

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