Provider Demographics
NPI:1659025575
Name:LAKE HOME HEALTH
Entity Type:Organization
Organization Name:LAKE HOME HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NAIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:DADYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:747-264-0421
Mailing Address - Street 1:6360 VAN NUYS BLVD STE 167
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91401-6657
Mailing Address - Country:US
Mailing Address - Phone:747-264-0421
Mailing Address - Fax:747-264-0422
Practice Address - Street 1:6360 VAN NUYS BLVD STE 167
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91401-6657
Practice Address - Country:US
Practice Address - Phone:747-264-0421
Practice Address - Fax:747-264-0422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-09
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health