Provida Home Health, Inc.

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

Legal business name

PROVIDA HOME HEALTH, INC.

Practice address

14545 Victory Blvd Ste 418
Van Nuys, CA 91411-4182

Phone

(818) 653-5454

NPI assigned

Jun 5, 2018

Last updated

Nov 7, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mery Balayan

Title

Ceo

Phone

(818) 653-5454

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 1225520109. Details of each certification follow.

• CCN 757688 Home health agency · Active · Details

Home health agency certification: CCN 757688

Legal name

PROVIDA HOME HEALTH, INC.

Certification status

Active

Provider type (POS)

Home health agency

Participating since

Aug 23, 2024

Last certification

Aug 22, 2024

Organization structure

CorporationProprietary

Incorporated

Dec 19, 2017 in CA

Enrollment address

14545 Victory Blvd
Ste 418
Van Nuys, CA 91411-4182
HHA Branch

Listed as

Provida Home Health, IncCCN 757688 · All quality measures

Ownership

-

Certified

Aug 23, 2024

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 1

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

Affiliated clinicians 2

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

• Michio Abe, MD

  • Internal Medicine Physician
  • Victorville, CA
  • NPI 1285669671

  Home health agency

  Care Compare affiliation
• Alex Foxman, M.D.

  • Internal Medicine Physician
  • Beverly Hills, CA
  • NPI 1013097831

  Home health agency

  Care Compare affiliation

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

{
    "created_epoch": "1528156800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1730937600000",
    "number": "1225520109",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14545 VICTORY BLVD STE 418",
            "city": "VAN NUYS",
            "state": "CA",
            "postal_code": "914114182"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14545 VICTORY BLVD STE 418",
            "city": "VAN NUYS",
            "state": "CA",
            "postal_code": "914114182",
            "telephone_number": "818-653-5454"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDA HOME HEALTH, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-06-05",
        "last_updated": "2024-11-07",
        "certification_date": "2024-11-07",
        "status": "A",
        "authorized_official_last_name": "BALAYAN",
        "authorized_official_first_name": "MERY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "818-653-5454"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Home Health Agency in Van Nuys, CA
• Providers in Van Nuys, CA by specialty
• Home Health Agency in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2024; 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.