Provider Demographics
NPI:1659979433
Name:DIVERSITY HOME HEALTH INC
Entity Type:Organization
Organization Name:DIVERSITY HOME HEALTH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:VILEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MANTSKANYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-813-3600
Mailing Address - Street 1:229 N CENTRAL AVE STE 402
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91203-3542
Mailing Address - Country:US
Mailing Address - Phone:818-396-5296
Mailing Address - Fax:
Practice Address - Street 1:229 N CENTRAL AVE STE 402
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203-3542
Practice Address - Country:US
Practice Address - Phone:818-396-5296
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-13
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4603512Medicaid