Provider Demographics
NPI:1992366678
Name:AVANTA HOME HEALTH SERVICES
Entity Type:Organization
Organization Name:AVANTA HOME HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SOFI
Authorized Official - Middle Name:
Authorized Official - Last Name:KNYAZYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:747-300-8989
Mailing Address - Street 1:620 W ROUTE 66 STE 216
Mailing Address - Street 2:
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91740-4173
Mailing Address - Country:US
Mailing Address - Phone:747-300-8989
Mailing Address - Fax:
Practice Address - Street 1:620 W ROUTE 66 STE 216
Practice Address - Street 2:
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91740-4173
Practice Address - Country:US
Practice Address - Phone:747-300-8989
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-24
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health