Provider Demographics
NPI:1619544640
Name:AVENUE HOME HEALTH, INC
Entity Type:Organization
Organization Name:AVENUE HOME HEALTH, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GILBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:TER-HOVHANNISYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-858-0976
Mailing Address - Street 1:14402 HAYNES ST STE 203
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91401-1482
Mailing Address - Country:US
Mailing Address - Phone:818-858-0976
Mailing Address - Fax:
Practice Address - Street 1:14402 HAYNES ST STE 203
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91401-1482
Practice Address - Country:US
Practice Address - Phone:818-858-0976
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-08
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health