Provider Demographics
NPI:1912039397
Name:LIBERTY HOME HEALTH CARE, INC.
Entity Type:Organization
Organization Name:LIBERTY HOME HEALTH CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:HAKOP
Authorized Official - Middle Name:
Authorized Official - Last Name:TIFLIZYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-662-8080
Mailing Address - Street 1:125 E GLENOAKS BLVD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91207-2036
Mailing Address - Country:US
Mailing Address - Phone:818-662-8080
Mailing Address - Fax:818-662-8788
Practice Address - Street 1:125 E GLENOAKS BLVD
Practice Address - Street 2:SUITE 104
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91207-2036
Practice Address - Country:US
Practice Address - Phone:818-662-8080
Practice Address - Fax:818-662-8788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA550000498251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA058471Medicare Oscar/Certification