Provider Demographics
NPI:1306379383
Name:ANGEL OF MERCY HOME HEALTH CARE
Entity type:Organization
Organization Name:ANGEL OF MERCY HOME HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:GRAND
Authorized Official - Middle Name:
Authorized Official - Last Name:OGANESYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-937-9440
Mailing Address - Street 1:1110 SONORA AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91201-3166
Mailing Address - Country:US
Mailing Address - Phone:818-937-9440
Mailing Address - Fax:818-937-9441
Practice Address - Street 1:1110 SONORA AVE STE 102
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91201-3166
Practice Address - Country:US
Practice Address - Phone:818-937-9440
Practice Address - Fax:818-937-9441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-06
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1306379383Medicaid
CA550004502OtherCA LICENSE