Provider Demographics
NPI:1114920931
Name:AMITY HOME HEALTH INC
Entity Type:Organization
Organization Name:AMITY HOME HEALTH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:EDNA
Authorized Official - Middle Name:P
Authorized Official - Last Name:CABANBAN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:818-831-8270
Mailing Address - Street 1:17042 DEVONSHIRE ST
Mailing Address - Street 2:STE 220
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91325-1679
Mailing Address - Country:US
Mailing Address - Phone:818-831-8270
Mailing Address - Fax:818-831-8272
Practice Address - Street 1:17042 DEVONSHIRE ST
Practice Address - Street 2:STE 220
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91325-1679
Practice Address - Country:US
Practice Address - Phone:818-831-8270
Practice Address - Fax:818-831-8272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHHA08268FMedicaid
CAHHA08268FMedicaid