Organization Active NPI

Red Star Home Health Care, Inc

  • Home Health Agency
  • Los Angeles, CA
National Provider Identifier
1104490283
Registry record updated Oct 20, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
Legal business name
RED STAR HOME HEALTH CARE, INC
Practice address
3171 Los Feliz Blvd Ste 312
Los Angeles, CA 90039-1537
Phone
(323) 741-0056
Fax
(323) 544-0966
NPI assigned
May 13, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 20, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Gevorg Panadzhyan
Title
Ceo
Phone
(323) 741-0056

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X Primary

Addresses

Primary practice location

3171 Los Feliz Blvd Ste 312
Los Angeles, CA 90039-1537

Mailing address

3171 Los Feliz Blvd Ste 312
Los Angeles, CA 90039-1537
Phone (323) 741-0056

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20221018000786 CA Part A Provider - Home Health Agency 3577939446 Practice locations: Burbank, CA

Home health agency certification: CCN 757338

Legal name
RED STAR HOME HEALTH CARE INC
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Aug 8, 2023
Last certification
Aug 8, 2023
Organization structure
CorporationProprietary
Incorporated
Dec 15, 2020 in CA
Enrollment address
215 W Alameda Ave
Ste 105
Burbank, CA 91502-3061

Care Compare: Home health agency

Medicare Care Compare
Listed as
Red Star Home Health Care, IncCCN 757338
Ownership
-
Certified
Aug 8, 2023
Medicare certification status
ActiveFrom the Provider of Services file

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D2304156Red Star Home Health Care, Inc3171 Los Feliz Blvd, Ste 310, Los Angeles, CA 90039Certificate of waiverMay 7, 2028

National Provider Directory

National Provider Directory

Locations

215 W Alameda Ave
Ste 105
Burbank, CA 91502
Phone (323) 741-0056

3171 Los Feliz Blvd
Ste 312
Los Angeles, CA 90039
Phone (323) 741-0056

Ownership & related parties

All disclosed owners & managing parties 1

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Gevorg Panadzhyan Individual 5% Or Greater Direct Ownership Interest Dec 15, 2020 100%
Corporate Officer Dec 15, 2020
Corporate Director Dec 15, 2020
W-2 Managing Employee Dec 15, 2020

Practitioners & affiliated clinicians

Affiliated clinicians 1

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1620864000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1666224000000",
    "number": "1104490283",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3171 LOS FELIZ BLVD STE 312",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900391537",
            "telephone_number": "323-741-0056",
            "fax_number": "323-544-0966"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3171 LOS FELIZ BLVD STE 312",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900391537",
            "telephone_number": "323-741-0056",
            "fax_number": "323-544-0966"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RED STAR HOME HEALTH CARE, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-05-13",
        "last_updated": "2022-10-20",
        "certification_date": "2022-10-20",
        "status": "A",
        "authorized_official_last_name": "PANADZHYAN",
        "authorized_official_first_name": "GEVORG",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "323-741-0056"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.