Provider Demographics
NPI:1760921746
Name:SOUTHERN STAR HOME HEALTHCARE, INC.
Entity Type:Organization
Organization Name:SOUTHERN STAR HOME HEALTHCARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:TEVAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KHUDANYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-446-2265
Mailing Address - Street 1:1011 W LA PALMA AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-3661
Mailing Address - Country:US
Mailing Address - Phone:818-446-2265
Mailing Address - Fax:818-446-2326
Practice Address - Street 1:1011 W LA PALMA AVE STE 102
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-3661
Practice Address - Country:US
Practice Address - Phone:818-446-2265
Practice Address - Fax:818-446-2326
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-23
Last Update Date:2019-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health