Angel Wings Home Health Agency

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

Legal business name

ANGEL WINGS HOME HEALTH AGENCY

Practice address

1443 N Highland Ave Ste 1
Los Angeles, CA 90028-7622

Phone

(818) 422-4060

NPI assigned

Jan 11, 2022

Last updated

Jan 11, 2022By 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

Ruben Mkhitaryan

Title

Ceo

Phone

(818) 422-4060

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 1306597323. Details of each certification follow.

• CCN 757633 Home health agency · Active · Details

Home health agency certification: CCN 757633

Legal name

ANGEL WINGS HOME HEALTH AGENCY

Certification status

Active

Provider type (POS)

Home health agency

Participating since

Apr 26, 2024

Last certification

Apr 18, 2024

Organization structure

CorporationProprietary

Incorporated

Jan 4, 2022 in CA

Enrollment address

1443 N Highland Ave
Ste 1
Los Angeles, CA 90028-7622

Listed as

Angel Wings Home Health AgencyCCN 757633 · All quality measures

Overall star rating

3 of 5

Ownership

-

Certified

Apr 26, 2024

Medicare certification status

ActiveFrom the Provider of Services file

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.

• Terrill K. Haws, D.O.

  • General Practice Physician
  • Dana Point, CA
  • NPI 1275742223

  Home health agency

  Care Compare affiliation
• Gihan S Abdel-Samed, MD

  • Emergency Medicine Physician
  • Milton, GA
  • NPI 1306884754

  Home health agency

  Care Compare affiliation

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

{
    "created_epoch": "1641859200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1641859200000",
    "number": "1306597323",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1443 N HIGHLAND AVE STE 1",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900287622"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1443 N HIGHLAND AVE STE 1",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900287622",
            "telephone_number": "818-422-4060"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANGEL WINGS HOME HEALTH AGENCY",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-01-11",
        "last_updated": "2022-01-11",
        "certification_date": "2022-01-11",
        "status": "A",
        "authorized_official_last_name": "MKHITARYAN",
        "authorized_official_first_name": "RUBEN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "818-422-4060"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Raul Angel
• Victor Angel

• Home Health Agency in Los Angeles, CA
• Providers in Los Angeles, 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 Jan 11, 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.