Provider Demographics
NPI:1407352651
Name:PRIMAVERA HOME HEALTH, INC.
Entity Type:Organization
Organization Name:PRIMAVERA HOME HEALTH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:VAHE
Authorized Official - Middle Name:
Authorized Official - Last Name:DEMIRCHYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:747-222-6507
Mailing Address - Street 1:1241 S GLENDALE AVE STE 204A
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91205-3385
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1241 S GLENDALE AVE STE 204A
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91205-3385
Practice Address - Country:US
Practice Address - Phone:747-222-6507
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-04
Last Update Date:2018-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health