Holy Light Home Health, Inc.

Primary specialty

Community Based Hospice Care AgencyTaxonomy code 251G00000X

Legal business name

HOLY LIGHT HOME HEALTH, INC.

Practice address

14545 Friar St Ste 362
Van Nuys, CA 91411-2397

Phone

(818) 345-9069

NPI assigned

Apr 19, 2021

Last updated

May 18, 2021By the provider in NPPES

Organization subpart

Yes

Parent organization

ANNDRELEX MANAGEMENT, INC.As reported in NPPES

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

Authorized official

Name

Kristine Arutyunyan

Title

Ceo

Phone

(818) 345-9069

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1205417466. Details of each certification follow.

• CCN 757300 Home health agency · Active · Details

Home health agency certification: CCN 757300

Legal name

HOLY LIGHT HOME HEALTH INC

Certification status

Active

Provider type (POS)

Home health agency

Participating since

May 23, 2023

Last certification

May 11, 2023

Organization structure

CorporationProprietary

Incorporated

Apr 6, 2021 in CA

Enrollment address

300 N Third St
Ste 302
Burbank, CA 91502-2397
HHA Branch

Listed as

Holy Light Home Health, Inc.CCN 757300 · All quality measures

Overall star rating

4 of 5

Ownership

-

Certified

May 23, 2023

Medicare certification status

ActiveFrom the Provider of Services file

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

CLIA laboratory certificates

Locations

All disclosed owners & managing parties 2

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

Affiliated clinicians 3

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

• David Fahim, DO

  • Family Medicine Physician
  • San Dimas, CA
  • NPI 1396481891

  Home health agency

  Care Compare affiliation
• Maxwell Jen, MD

  • Emergency Medicine Physician
  • Tustin, CA
  • NPI 1154688810

  Home health agency

  Care Compare affiliation
• Bisharah Syeda Rizvi, MD

  • Hospitalist Physician
  • Phoenix, AZ
  • NPI 1447693882

  Home health agency

  Care Compare affiliation

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

{
    "created_epoch": "1618790400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1621296000000",
    "number": "1205417466",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14545 FRIAR ST STE 362",
            "city": "VAN NUYS",
            "state": "CA",
            "postal_code": "914112397",
            "telephone_number": "818-345-9069"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14545 FRIAR ST STE 362",
            "city": "VAN NUYS",
            "state": "CA",
            "postal_code": "914112397",
            "telephone_number": "818-345-9069"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HOLY LIGHT HOME HEALTH, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ANNDRELEX MANAGEMENT, INC.",
        "enumeration_date": "2021-04-19",
        "last_updated": "2021-05-18",
        "certification_date": "2021-05-18",
        "status": "A",
        "authorized_official_last_name": "ARUTYUNYAN",
        "authorized_official_first_name": "KRISTINE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "818-345-9069"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Zachary Holmes
• Bjorn Holsborg
• Marisa Ann Holt
• Holy Care Home Health and Pallative Care
• Holy Care Home Health and Palliative Care
• Melissa Y Hom
• Home Care America LLC (Home Care America)
• Home Foot Care, Inc.
• Home for All Boarding Care Inc
• Home Health Professionals, Inc.

• Community Based Hospice Care Agency in Van Nuys, CA
• Providers in Van Nuys, CA by specialty
• Community Based Hospice Care Agency in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.