Provider Demographics
NPI:1578886651
Name:CORE HOME HEALTH AGENCY, INC.
Entity Type:Organization
Organization Name:CORE HOME HEALTH AGENCY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:GURAM
Authorized Official - Middle Name:
Authorized Official - Last Name:MARGALITZADE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-637-2673
Mailing Address - Street 1:421 ARDEN AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91203-4008
Mailing Address - Country:US
Mailing Address - Phone:818-637-2673
Mailing Address - Fax:818-484-2074
Practice Address - Street 1:421 ARDEN AVE
Practice Address - Street 2:SUITE B
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203-4008
Practice Address - Country:US
Practice Address - Phone:818-637-2673
Practice Address - Fax:818-484-2074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-03
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
059443OtherMEDICARE PROVIDER NUMBER