Provider Demographics
NPI:1184185548
Name:PREFERRED HOME HEALTH SERVICES
Entity Type:Organization
Organization Name:PREFERRED HOME HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SUREN
Authorized Official - Middle Name:
Authorized Official - Last Name:AVETISYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-495-0003
Mailing Address - Street 1:40 N ATLANDENA DR SUITE 219
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91107
Mailing Address - Country:US
Mailing Address - Phone:626-495-0003
Mailing Address - Fax:
Practice Address - Street 1:40 N ATLANDENA DR SUITE 219
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91107
Practice Address - Country:US
Practice Address - Phone:626-495-0003
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-28
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1Medicaid