Provider Demographics
NPI:1114499852
Name:MOBILE-CARE HOME HEALTH AGENCY, INC
Entity Type:Organization
Organization Name:MOBILE-CARE HOME HEALTH AGENCY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ARBI
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVTYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:747-281-2303
Mailing Address - Street 1:4419 VAN NUYS BLVD STE 404
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-5741
Mailing Address - Country:US
Mailing Address - Phone:747-281-2303
Mailing Address - Fax:747-281-2301
Practice Address - Street 1:4419 VAN NUYS BLVD STE 404
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-5741
Practice Address - Country:US
Practice Address - Phone:747-281-2303
Practice Address - Fax:747-281-2301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-19
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1114499852Medicaid