NPIMap

Organization Active NPI

Jax Home Health, Inc

  • Home Health Agency
  • Glendale, CA
National Provider Identifier
1972170082
Registry record updated Jun 8, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
Legal business name
JAX HOME HEALTH, INC
Practice address
230 N Maryland Ave Ste 301
Glendale, CA 91206-4281
Phone
(747) 877-9240
NPI assigned
Jun 8, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 8, 2021

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

Authorized official

Name
Jacqueline Panossian
Title
Ceo
Phone
(747) 877-9240

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X Primary

Addresses

Primary practice location

230 N Maryland Ave Ste 301
Glendale, CA 91206-4281

Mailing address

230 N Maryland Ave Ste 301
Glendale, CA 91206-4281

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210826000154 CA Part A Provider - Home Health Agency 6608271861 Practice locations: Glendale, CA

Home health agency certification: CCN 757189

Legal name
JAX HOME HEALTH INC
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Feb 22, 2023
Last certification
Feb 22, 2023
Organization structure
CorporationProprietary
Incorporated
May 26, 2021 in CA
Enrollment address
230 N Maryland Ave
Ste 301
Glendale, CA 91206-4281

Care Compare: Home health agency

Medicare Care Compare
Listed as
Jax Home Health, IncCCN 757189
Overall star rating
2.5 of 5
Ownership
-
Certified
Feb 22, 2023
Medicare certification status
ActiveFrom the Provider of Services file

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D2303463Jax Home Health Inc230 N Maryland Ave Ste 301, Glendale, CA 91206Certificate of waiverApr 24, 2028

National Provider Directory

National Provider Directory

Locations

230 N Maryland Ave
Ste 301
Glendale, CA 91206
Phone (747) 877-9240

Ownership & related parties

All disclosed owners & managing parties 3

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

NameRoleSinceShare
Arsen Avedisyan Individual 5% Or Greater Indirect Ownership Interest Jul 10, 2023 50%
Corporate OfficerCfo Jul 10, 2023
Corporate DirectorCfo Jul 10, 2023
W-2 Managing EmployeeCfo Jul 10, 2023
Jax Med Group Inc Organization, Glendale, CA Created for acquisition, Corporation 5% Or Greater Direct Ownership Interest May 26, 2021 100%
Susanna Grigoryan Individual 5% Or Greater Indirect Ownership Interest Jul 10, 2023 50%
Corporate OfficerCeo/Secretary Jul 10, 2023
Corporate DirectorCeo/Secretary Jul 10, 2023
W-2 Managing EmployeeCeo/Secretary Jul 10, 2023

Practitioners & affiliated clinicians

Affiliated clinicians 10

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

NPI Registry JSON

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

{
    "created_epoch": "1623110400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1623110400000",
    "number": "1972170082",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "230 N MARYLAND AVE STE 301",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912064281"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "230 N MARYLAND AVE STE 301",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912064281",
            "telephone_number": "747-877-9240"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JAX HOME HEALTH, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-06-08",
        "last_updated": "2021-06-08",
        "certification_date": "2021-06-08",
        "status": "A",
        "authorized_official_last_name": "PANOSSIAN",
        "authorized_official_first_name": "JACQUELINE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "747-877-9240"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Glendale, CA

Sources for this page

Verify at the official NPI Registry.