Provital Care, Inc.

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

Legal business name

PROVITAL CARE, INC.

Practice address

20953 Devonshire St Ste 6
Chatsworth, CA 91311-2371

Phone

(747) 282-1555

NPI assigned

Mar 3, 2020

Organization subpart

No

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

Authorized official

Name

Irina Grigoryan

Title

Ceo

Phone

(747) 282-1555

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 1346874062. Details of each certification follow.

• CCN 559467 Home health agency · Active · Details

Home health agency certification: CCN 559467

Legal name

PROVITAL CARE INC

Certification status

Active

Provider type (POS)

Home health agency

Participating since

May 5, 2021

Last certification

May 5, 2021

Ownership / control type

Proprietary

Organization structure

CorporationProprietary

Enrollment address

20953 Devonshire St
Ste 6
Chatsworth, CA 91311-2371

Listed as

Provital Care, IncCCN 559467 · All quality measures

Ownership

Proprietary

Certified

May 5, 2021

Medicare certification status

ActiveFrom the Provider of Services file

Services

Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy

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.

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

• Anna Manukyan

  • Primary Care Nurse Practitioner
  • Glendale, CA
  • NPI 1003445768

  Contracted Managing Employee

  CMS ownership

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

{
    "created_epoch": "1583193600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1583193600000",
    "number": "1346874062",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20953 DEVONSHIRE ST STE 6",
            "city": "CHATSWORTH",
            "state": "CA",
            "postal_code": "913112371",
            "telephone_number": "747-282-1555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20953 DEVONSHIRE ST STE 6",
            "city": "CHATSWORTH",
            "state": "CA",
            "postal_code": "913112371",
            "telephone_number": "747-282-1555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVITAL CARE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-03-03",
        "last_updated": "2020-03-03",
        "certification_date": "2020-03-03",
        "status": "A",
        "authorized_official_last_name": "GRIGORYAN",
        "authorized_official_first_name": "IRINA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "747-282-1555"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kenneth R Prescott, MSW, LCSW
• Haley Preston-Hotaki, RN
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• Alex Primo, LMFT
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• Psych Assessments Psychology Inc (Psych Assessments)
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• Pure Golden Hospice Inc
• Quality Care Physical Therapy P.C.
• Quality Living Care

• Home Health Agency in Chatsworth, CA
• Providers in Chatsworth, 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 Mar 3, 2020; 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.