Open Life Home Health, Inc.

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

Legal business name

OPEN LIFE HOME HEALTH, INC.

Practice address

6740 Vesper Ave Ste 203
Van Nuys, CA 91405-4612

Phone

(818) 616-8479

Fax

(818) 616-8487

NPI assigned

Sep 18, 2017

Organization subpart

No

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

Authorized official

Name

Kevork Khrayan

Title

Ceo

Phone

(818) 616-8479

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Home health agency certification: CCN 753166

Legal name

OPEN LIFE HOME HEALTH, INC.

Certification status

Active

Provider type (POS)

Home health agency

Participating since

Jul 25, 2022

Last certification

Jul 14, 2022

Organization structure

CorporationProprietary

Incorporated

Sep 7, 2017 in CA

Enrollment address

6740 Vesper Ave
Ste 203
Van Nuys, CA 91405-4612
HHA Branch

Listed as

Open Life Home Health, IncCCN 753166

Ownership

-

Certified

Jul 25, 2022

Medicare certification status

ActiveFrom the Provider of Services file

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.

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

{
    "created_epoch": "1505692800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1265951537",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6740 VESPER AVE STE 203",
            "city": "VAN NUYS",
            "state": "CA",
            "postal_code": "914054612",
            "telephone_number": "818-616-8479",
            "fax_number": "818-616-8487"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6740 VESPER AVE STE 203",
            "city": "VAN NUYS",
            "state": "CA",
            "postal_code": "914054612",
            "telephone_number": "818-616-8479",
            "fax_number": "818-616-8487"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPEN LIFE HOME HEALTH, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-09-18",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "KHRAYAN",
        "authorized_official_first_name": "KEVORK",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "818-616-8479"
    },
    "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 California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.