Provider Demographics
NPI:1508424144
Name:MEDPLUS HOME HEALTH,INC.
Entity Type:Organization
Organization Name:MEDPLUS HOME HEALTH,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:AVANESOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-510-0226
Mailing Address - Street 1:14664 VICTORY BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91411-1621
Mailing Address - Country:US
Mailing Address - Phone:818-510-0226
Mailing Address - Fax:818-790-2255
Practice Address - Street 1:14664 VICTORY BLVD STE 200
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91411-1621
Practice Address - Country:US
Practice Address - Phone:818-510-0226
Practice Address - Fax:818-790-2255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-30
Last Update Date:2019-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health