Provider Demographics
NPI:1215406905
Name:PROSPECT HOME HEALTHCARE, LLC
Entity Type:Organization
Organization Name:PROSPECT HOME HEALTHCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/CFO
Authorized Official - Prefix:
Authorized Official - First Name:SHAMAM
Authorized Official - Middle Name:
Authorized Official - Last Name:HARUTYUNYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-849-5428
Mailing Address - Street 1:7120 HAYVENHURST AVE STE 206
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91406-3813
Mailing Address - Country:US
Mailing Address - Phone:818-849-5428
Mailing Address - Fax:818-849-5837
Practice Address - Street 1:7120 HAYVENHURST AVE STE 206
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91406-3813
Practice Address - Country:US
Practice Address - Phone:818-849-5428
Practice Address - Fax:818-849-5837
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-25
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health