Provider Demographics
NPI:1942608724
Name:SO CAL HHA
Entity Type:Organization
Organization Name:SO CAL HHA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BAGIRYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-505-9500
Mailing Address - Street 1:11507 OXNARD ST
Mailing Address - Street 2:SUITE # 4
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91606-4809
Mailing Address - Country:US
Mailing Address - Phone:818-505-9500
Mailing Address - Fax:818-505-9505
Practice Address - Street 1:11507 OXNARD ST
Practice Address - Street 2:SUITE # 4
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91606-4809
Practice Address - Country:US
Practice Address - Phone:818-505-9500
Practice Address - Fax:818-505-9505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-10
Last Update Date:2014-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health