Provider Demographics
NPI:1245954916
Name:OPAL HOME HEALTH, INC.
Entity type:Organization
Organization Name:OPAL HOME HEALTH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:ANUSH
Authorized Official - Middle Name:
Authorized Official - Last Name:PETIKYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-614-3332
Mailing Address - Street 1:5301 LAUREL CANYON BLVD # 237B
Mailing Address - Street 2:
Mailing Address - City:VALLEY VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91607-2736
Mailing Address - Country:US
Mailing Address - Phone:818-614-3332
Mailing Address - Fax:818-614-3332
Practice Address - Street 1:5301 LAUREL CANYON BLVD # 237B
Practice Address - Street 2:
Practice Address - City:VALLEY VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91607-2736
Practice Address - Country:US
Practice Address - Phone:818-614-3332
Practice Address - Fax:818-614-3332
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HERITAGE INVESTMENTS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-09-27
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health