Provider Demographics
NPI:1720228018
Name:LOYAL HOME HEALTH CARE, INC.
Entity Type:Organization
Organization Name:LOYAL HOME HEALTH CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:NELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:TADEVOSYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-583-1233
Mailing Address - Street 1:2139 TAPO ST STE 208
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93063-3476
Mailing Address - Country:US
Mailing Address - Phone:805-583-1233
Mailing Address - Fax:
Practice Address - Street 1:2139 TAPO ST STE 208
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93063-3476
Practice Address - Country:US
Practice Address - Phone:805-583-1233
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-25
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA059295Medicare Oscar/Certification