Provider Demographics
NPI:1386840460
Name:ENVISION HOME HEALTH SERVICE INC
Entity Type:Organization
Organization Name:ENVISION HOME HEALTH SERVICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:KEGEYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-522-9252
Mailing Address - Street 1:17725 CRENSHAW BLVD STE #302
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90504
Mailing Address - Country:US
Mailing Address - Phone:310-515-1246
Mailing Address - Fax:310-515-1721
Practice Address - Street 1:17725 CRENSHAW BLVD STE #302
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90504
Practice Address - Country:US
Practice Address - Phone:310-515-1246
Practice Address - Fax:310-515-1721
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-25
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANONE YET251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA059172Medicare Oscar/Certification