Provida Home Health, Inc.
Organization Active NPI Home Health Agency · Van Nuys, CA
NPI 1225520109 · NPPES record last updated Nov 7, 2024
Key facts
- NPI
- 1225520109
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Home Health Agency 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
- Organization subpart
- No
Authorized official
- Name
- Mery Balayan
- Title
- Ceo
- Phone
- (818) 653-5454
Affiliated clinicians 2
-
Michio Abe, MD
-
Alex Foxman, M.D.
Medicare Care Compare: Home health agency
- Listed as
- Provida Home Health, Inc
- Ownership
- -
- Certified
- Aug 23, 2024
- Medicare certification status
- Active
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 05D2322674 | Provida Home Health, Inc | Certificate of waiver | Apr 23, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
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
- Corporation · Proprietary
- Incorporated
- Dec 19, 2017 in CA
- Enrollment address
- 14545 Victory Blvd
Ste 418
Van Nuys, CA 91411-4182
All disclosed owners & managing parties 1
| Name | Role | Since | Share |
|---|---|---|---|
| Mery Balayan |
5% Or Greater Direct Ownership Interest |
Dec 19, 2017 | 100% |
| Corporate Officer |
Dec 19, 2017 | 100% | |
| Corporate Director |
Dec 19, 2017 | 100% | |
| W-2 Managing Employee |
Dec 19, 2017 | 100% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20190812000018 | CA | Part a Provider - Home Health Agency | 5294062485 | Practice locations: Van Nuys, CA |
National Provider Directory
Locations
14545 Victory Blvd
Ste 418
Van Nuys, CA 91411
Phone (818) 528-8798
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Home Health Agency | 251E00000X | Yes |
Addresses
Primary practice location
14545 Victory Blvd Ste 418
Van Nuys, CA 91411-4182
Mailing address
14545 Victory Blvd Ste 418
Van Nuys, CA 91411-4182
Other providers in Van Nuys, CA
- Prosperity Home Health
- Prosthetic & Orthotic Group San Gabriel Valley, Inc
- Protection Home Health Care Inc
- Proton Healthcare
- Proud to Serve Home Health Care Inc.
- Provision Home Healthcare
- Prowalk Orthotics & Prosthetics, Inc.
- Prudence Home Health Care Inc.
- Prudent Hospice Care Inc
- Prudent Hospice Care Inc.
All providers in Van Nuys, CA · Home Health Agency in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 7, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.