Provider Demographics
NPI:1659844439
Name:WISH HOME HEALTH CARE, INC
Entity Type:Organization
Organization Name:WISH HOME HEALTH CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RUZAN
Authorized Official - Middle Name:
Authorized Official - Last Name:AGHALYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-616-2022
Mailing Address - Street 1:500 E OLIVE AVE STE 670
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91501-2197
Mailing Address - Country:US
Mailing Address - Phone:818-616-2022
Mailing Address - Fax:818-616-2023
Practice Address - Street 1:6422 VAN NUYS BLVD STE 102
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91401-1436
Practice Address - Country:US
Practice Address - Phone:818-616-2022
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-04
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1Medicaid