Provider Demographics
NPI:1295319929
Name:HOLLYWOOD PREMIUM HOME CARE, INC.
Entity type:Organization
Organization Name:HOLLYWOOD PREMIUM HOME CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, CEO, CFO, SECRETARY
Authorized Official - Prefix:MR
Authorized Official - First Name:ARTYOM
Authorized Official - Middle Name:
Authorized Official - Last Name:TUMANYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-484-4488
Mailing Address - Street 1:1110 N WESTERN AVE STE 109
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90029-1087
Mailing Address - Country:US
Mailing Address - Phone:323-484-4488
Mailing Address - Fax:323-978-5551
Practice Address - Street 1:1110 N WESTERN AVE STE 109
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90029-1087
Practice Address - Country:US
Practice Address - Phone:323-484-4488
Practice Address - Fax:323-978-5551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-10
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health