Provider Demographics
NPI:1770141889
Name:MEDPROF HOME HEALTH CARE, INC.
Entity type:Organization
Organization Name:MEDPROF HOME HEALTH CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KIRSTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:MIKAYELYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-646-0143
Mailing Address - Street 1:7540 BALBOA BLVD STE 9
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91406-2771
Mailing Address - Country:US
Mailing Address - Phone:818-646-0143
Mailing Address - Fax:
Practice Address - Street 1:7540 BALBOA BLVD STE 9
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91406-2771
Practice Address - Country:US
Practice Address - Phone:818-646-0143
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-04
Last Update Date:2019-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1Medicaid