Provider Demographics
NPI:1649843210
Name:CITY OF ANGELS HOME HEALTH, INC.
Entity type:Organization
Organization Name:CITY OF ANGELS HOME HEALTH, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DOPCS
Authorized Official - Prefix:
Authorized Official - First Name:ANAHITA
Authorized Official - Middle Name:
Authorized Official - Last Name:YAZDANI
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:818-914-5861
Mailing Address - Street 1:22141 VENTURA BLVD
Mailing Address - Street 2:SUITE #207
Mailing Address - City:WOODLAND HLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364
Mailing Address - Country:US
Mailing Address - Phone:818-914-5861
Mailing Address - Fax:818-337-7406
Practice Address - Street 1:22141 VENTURA BLVD
Practice Address - Street 2:SUITE #207
Practice Address - City:WOODLAND HLS
Practice Address - State:CA
Practice Address - Zip Code:91364
Practice Address - Country:US
Practice Address - Phone:818-914-5861
Practice Address - Fax:818-337-7406
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-21
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA550006425OtherSTATE OF CALIFORNIA DEPARTMENT OF PUBLIC HEALTH
CA559537OtherPTAN / CCN NUMBER
CA559537Medicaid