Provider Demographics
NPI:1245321751
Name:LAVANDA HOME HEALTH CARE AGENCY INC
Entity type:Organization
Organization Name:LAVANDA HOME HEALTH CARE AGENCY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:JULIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-840-0003
Mailing Address - Street 1:2501 W BURBANK BLVD
Mailing Address - Street 2:SUITE 312
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-2347
Mailing Address - Country:US
Mailing Address - Phone:818-840-0003
Mailing Address - Fax:818-840-0069
Practice Address - Street 1:11490 BURBANK BLVD
Practice Address - Street 2:#3E
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91601-2389
Practice Address - Country:US
Practice Address - Phone:818-760-9656
Practice Address - Fax:818-760-9635
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2008-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA980001555251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA058334Medicare ID - Type UnspecifiedHOME HEALTH AGENCY