Provider Demographics
NPI:1083836183
Name:CELEBRITY HOMEHEALTH, INC.
Entity Type:Organization
Organization Name:CELEBRITY HOMEHEALTH, INC.
Other - Org Name:CELEBRITY HOMEHEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO, PRES.
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:BUSTAN
Authorized Official - Suffix:
Authorized Official - Credentials:ACCOUNTANT
Authorized Official - Phone:818-492-1700
Mailing Address - Street 1:14950 VENTURA BLVD
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-3455
Mailing Address - Country:US
Mailing Address - Phone:818-343-4001
Mailing Address - Fax:818-996-4001
Practice Address - Street 1:2510 S RURAL RD STE 102
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-2497
Practice Address - Country:US
Practice Address - Phone:480-966-8888
Practice Address - Fax:480-966-8892
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAPPLIED FOR251E00000X
AZHSPC6509251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ426407OtherHACCCS
AZHHA55555FMedicaid
AZHHA55555FMedicaid