Provider Demographics
NPI:1508153503
Name:MGA HOME CARE SERVICES INCORPORATION
Entity Type:Organization
Organization Name:MGA HOME CARE SERVICES INCORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO/CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:VARDUHI
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIGORYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:747-236-4372
Mailing Address - Street 1:16921 PARTHENIA ST STE 203
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91343-4559
Mailing Address - Country:US
Mailing Address - Phone:747-236-4372
Mailing Address - Fax:818-936-0864
Practice Address - Street 1:16921 PARTHENIA ST STE 203
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91343-4559
Practice Address - Country:US
Practice Address - Phone:747-236-4372
Practice Address - Fax:818-936-0864
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-29
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
551790Medicare Oscar/Certification