Provider Demographics
NPI:1710151055
Name:SAN FERNANDO VALLEY HOMECARE LLC
Entity Type:Organization
Organization Name:SAN FERNANDO VALLEY HOMECARE LLC
Other - Org Name:SALUS HOMECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:MORTENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-725-8742
Mailing Address - Street 1:630 ROOSEVELT
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92620-3621
Mailing Address - Country:US
Mailing Address - Phone:888-725-8742
Mailing Address - Fax:
Practice Address - Street 1:16800 DEVONSHIRE ST
Practice Address - Street 2:SUITE 215
Practice Address - City:GRANADA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91344-7403
Practice Address - Country:US
Practice Address - Phone:888-725-8742
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-17
Last Update Date:2011-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA200714610182251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health