Provider Demographics
NPI:1063410314
Name:M. Y. HOME HEALTH INC
Entity type:Organization
Organization Name:M. Y. HOME HEALTH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:YOLANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:JARVINA
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:818-895-1523
Mailing Address - Street 1:15300 DEVONSHIRE ST
Mailing Address - Street 2:STE 5
Mailing Address - City:MISSION HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91345-2781
Mailing Address - Country:US
Mailing Address - Phone:818-895-1523
Mailing Address - Fax:818-895-1540
Practice Address - Street 1:15300 DEVONSHIRE ST
Practice Address - Street 2:STE 5
Practice Address - City:MISSION HILLS
Practice Address - State:CA
Practice Address - Zip Code:91345-2781
Practice Address - Country:US
Practice Address - Phone:818-895-1523
Practice Address - Fax:818-895-1540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-11
Last Update Date:2012-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA980001218251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHHA08048FMedicaid
CA058048Medicare ID - Type UnspecifiedHOME HEALTH AGENCY