Provider Demographics
NPI:1063079010
Name:GREEN PATH HOME HEALTH
Entity type:Organization
Organization Name:GREEN PATH HOME HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ALEN
Authorized Official - Middle Name:
Authorized Official - Last Name:KESHISHYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-331-1913
Mailing Address - Street 1:12158 HAMLIN ST STE 2
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91606-1433
Mailing Address - Country:US
Mailing Address - Phone:818-331-1913
Mailing Address - Fax:
Practice Address - Street 1:12158 HAMLIN ST STE 2
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91606-1433
Practice Address - Country:US
Practice Address - Phone:818-331-1913
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-24
Last Update Date:2019-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health