Provider Demographics
NPI:1053081240
Name:VICTORVILLE HOME HEALTH
Entity Type:Organization
Organization Name:VICTORVILLE HOME HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:VERGINE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAKHBAZIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-613-9590
Mailing Address - Street 1:14360 ST ANDREWS DR STE 4A
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92395-4341
Mailing Address - Country:US
Mailing Address - Phone:818-279-1700
Mailing Address - Fax:
Practice Address - Street 1:14360 ST ANDREWS DR STE 4A
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-4341
Practice Address - Country:US
Practice Address - Phone:818-279-1700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-17
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health