Provider Demographics
NPI:1710223631
Name:MERCURY HOME HEALTH SERVICES INC
Entity Type:Organization
Organization Name:MERCURY HOME HEALTH SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ALAVERDYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:747-241-8593
Mailing Address - Street 1:1241 S GLENDALE AVE,
Mailing Address - Street 2:STE 305-D
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91205-3204
Mailing Address - Country:US
Mailing Address - Phone:818-925-6475
Mailing Address - Fax:818-459-6975
Practice Address - Street 1:2829 N GLENOAKS BLVD STE 104
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91504-2660
Practice Address - Country:US
Practice Address - Phone:747-241-8593
Practice Address - Fax:747-241-8596
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-20
Last Update Date:2019-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA550002600251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
059652Medicare Oscar/Certification