Provider Demographics
NPI:1104220623
Name:360 HOME HEALTH AGENCY
Entity Type:Organization
Organization Name:360 HOME HEALTH AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAFAYEL
Authorized Official - Middle Name:
Authorized Official - Last Name:NERSISYAN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:818-888-0100
Mailing Address - Street 1:20741 DOLOROSA ST
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367-6837
Mailing Address - Country:US
Mailing Address - Phone:818-888-0100
Mailing Address - Fax:
Practice Address - Street 1:21133 VICTORY BLVD
Practice Address - Street 2:SUITE 206
Practice Address - City:CANOGA PARK
Practice Address - State:CA
Practice Address - Zip Code:91303-2829
Practice Address - Country:US
Practice Address - Phone:818-888-0100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-13
Last Update Date:2014-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health