Provider Demographics
NPI:1013530112
Name:ANTELOPE VALLEY HOME HEALTH AGENCY INC.
Entity Type:Organization
Organization Name:ANTELOPE VALLEY HOME HEALTH AGENCY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:PONOMARENKO
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:661-407-2520
Mailing Address - Street 1:445 W PALMDALE BLVD STE L
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93551-4509
Mailing Address - Country:US
Mailing Address - Phone:661-407-2520
Mailing Address - Fax:661-480-5090
Practice Address - Street 1:445 W PALMDALE BLVD STE L
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93551-4509
Practice Address - Country:US
Practice Address - Phone:661-407-2520
Practice Address - Fax:661-480-5090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-22
Last Update Date:2020-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health