Provider Demographics
NPI:1164037321
Name:REJUVENATE HOME HEALTH, INC.
Entity Type:Organization
Organization Name:REJUVENATE HOME HEALTH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LILIT
Authorized Official - Middle Name:KARAPET
Authorized Official - Last Name:GEVORGYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-751-4420
Mailing Address - Street 1:6735 VAN NUYS BLVD STE 305
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91405-4645
Mailing Address - Country:US
Mailing Address - Phone:818-751-4420
Mailing Address - Fax:
Practice Address - Street 1:6735 VAN NUYS BLVD STE 305
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-4645
Practice Address - Country:US
Practice Address - Phone:818-751-4420
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:REJUVENATE HEALTHCARE INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-09-14
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health