Provider Demographics
NPI:1710558705
Name:PROVENCE HOME HEALTH CARE
Entity Type:Organization
Organization Name:PROVENCE HOME HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KARUSH
Authorized Official - Middle Name:
Authorized Official - Last Name:KIRAKOSYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-875-1462
Mailing Address - Street 1:5311 TOPANGA CANYON BLVD STE 213
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-1754
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5311 TOPANGA CANYON BLVD STE 213
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-1754
Practice Address - Country:US
Practice Address - Phone:818-875-1462
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRIME ADVISING
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-07-09
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health