Provider Demographics
NPI:1477211134
Name:SOCAL HOME HEALTH GROUP
Entity Type:Organization
Organization Name:SOCAL HOME HEALTH GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:MANTIZYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-640-5590
Mailing Address - Street 1:8138 FOOTHILL BLVD STE 330
Mailing Address - Street 2:
Mailing Address - City:SUNLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91040-2900
Mailing Address - Country:US
Mailing Address - Phone:818-640-5590
Mailing Address - Fax:800-310-0860
Practice Address - Street 1:8138 FOOTHILL BLVD STE 330
Practice Address - Street 2:
Practice Address - City:SUNLAND
Practice Address - State:CA
Practice Address - Zip Code:91040-2900
Practice Address - Country:US
Practice Address - Phone:818-640-5590
Practice Address - Fax:800-310-0860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-30
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health