Provider Demographics
NPI:1023078763
Name:CELEBRITY HEALTH SERVICES, INC.
Entity type:Organization
Organization Name:CELEBRITY HEALTH SERVICES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO, CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:BUSTAN
Authorized Official - Suffix:
Authorized Official - Credentials:ACCOUNTANT
Authorized Official - Phone:818-492-1700
Mailing Address - Street 1:14950 VENTURA BLVD
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-3455
Mailing Address - Country:US
Mailing Address - Phone:818-492-1700
Mailing Address - Fax:818-996-4001
Practice Address - Street 1:14950 VENTURA BLVD
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-3455
Practice Address - Country:US
Practice Address - Phone:818-492-1700
Practice Address - Fax:818-996-4001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-25
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPENDING163WH1000X
CA980001020251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
No163WH1000XNursing Service ProvidersRegistered NurseHospiceGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHHA5731FMedicaid
CA557731Medicare ID - Type UnspecifiedHOME CARE AGENCY