Provider Demographics
NPI:1124626569
Name:SHORE LINE HOME HEALTH, INC.
Entity type:Organization
Organization Name:SHORE LINE HOME HEALTH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GURGEN
Authorized Official - Middle Name:
Authorized Official - Last Name:HOVSEPYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:747-217-1839
Mailing Address - Street 1:6740 KESTER AVE STE 204D
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91405-4564
Mailing Address - Country:US
Mailing Address - Phone:747-217-1839
Mailing Address - Fax:
Practice Address - Street 1:6740 KESTER AVE STE 204D
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-4564
Practice Address - Country:US
Practice Address - Phone:747-217-1839
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOVSEPYAN INVESTMENTS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-10-16
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health