Provider Demographics
NPI:1740907963
Name:THIRD DOC HOME HEALTH
Entity type:Organization
Organization Name:THIRD DOC HOME HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LUSINE
Authorized Official - Middle Name:
Authorized Official - Last Name:NERSISYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-768-2361
Mailing Address - Street 1:440 WESTERN AVE UNIT 105B
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91201-2884
Mailing Address - Country:US
Mailing Address - Phone:626-768-2361
Mailing Address - Fax:626-768-1405
Practice Address - Street 1:440 WESTERN AVE UNIT 105B
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91201-2884
Practice Address - Country:US
Practice Address - Phone:626-768-2361
Practice Address - Fax:626-768-1405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-27
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health