Provider Demographics
NPI:1265654362
Name:CELEBRITY HOMEHEALTH INC.
Entity Type:Organization
Organization Name:CELEBRITY HOMEHEALTH INC.
Other - Org Name:CELEBRITY HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO/SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:BUSTAN
Authorized Official - Suffix:
Authorized Official - Credentials:ACCOUNTANT
Authorized Official - Phone:818-343-4001
Mailing Address - Street 1:14950 VENTURA BLVD
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-3455
Mailing Address - Country:US
Mailing Address - Phone:818-343-4001
Mailing Address - Fax:818-996-4001
Practice Address - Street 1:942 W FOOTHILL BLVD STE B
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-3783
Practice Address - Country:US
Practice Address - Phone:909-931-3888
Practice Address - Fax:909-931-3133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA550000588251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA8698138OtherMEDICAL
CA058439Medicare PIN