Provider Demographics
NPI:1881242378
Name:LA VIDA HOME HEALTH, INC.
Entity type:Organization
Organization Name:LA VIDA HOME HEALTH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:HAYK
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIGORYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-694-1640
Mailing Address - Street 1:12610 GLENOAKS BLVD STE 4
Mailing Address - Street 2:
Mailing Address - City:SYLMAR
Mailing Address - State:CA
Mailing Address - Zip Code:91342-4785
Mailing Address - Country:US
Mailing Address - Phone:310-694-1640
Mailing Address - Fax:
Practice Address - Street 1:12610 GLENOAKS BLVD STE 4
Practice Address - Street 2:
Practice Address - City:SYLMAR
Practice Address - State:CA
Practice Address - Zip Code:91342-4785
Practice Address - Country:US
Practice Address - Phone:310-694-1640
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-28
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health