Provider Demographics
NPI:1588336655
Name:VIVARA HOME HEALTH AGENCY, INC.
Entity type:Organization
Organization Name:VIVARA HOME HEALTH AGENCY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/CFO/SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:EMMA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIGORYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-312-6316
Mailing Address - Street 1:2149 E GARVEY AVE N STE B-6
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91791-1538
Mailing Address - Country:US
Mailing Address - Phone:818-312-6316
Mailing Address - Fax:
Practice Address - Street 1:2149 E GARVEY AVE N STE B-6
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91791-1538
Practice Address - Country:US
Practice Address - Phone:818-312-6316
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-28
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health