Provider Demographics
NPI:1285096198
Name:ACACIA HH&P OF SOUTHERN CALIFORNIA, LLC
Entity type:Organization
Organization Name:ACACIA HH&P OF SOUTHERN CALIFORNIA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:AGAZARYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-335-5515
Mailing Address - Street 1:11770 WARNER AVE
Mailing Address - Street 2:102
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-2663
Mailing Address - Country:US
Mailing Address - Phone:949-335-5515
Mailing Address - Fax:949-335-5519
Practice Address - Street 1:11770 WARNER AVE
Practice Address - Street 2:102
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-2663
Practice Address - Country:US
Practice Address - Phone:949-335-5515
Practice Address - Fax:949-335-5519
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-22
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health