Provider Demographics
NPI:1780466607
Name:FOURTH DOC HOME HEALTH CARE
Entity type:Organization
Organization Name:FOURTH DOC HOME HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LUSINE
Authorized Official - Middle Name:
Authorized Official - Last Name:NERSISYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-282-9136
Mailing Address - Street 1:1314 W GLENOAKS BLVD STE 101C
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91201-1978
Mailing Address - Country:US
Mailing Address - Phone:205-282-9136
Mailing Address - Fax:205-974-3248
Practice Address - Street 1:1314 W GLENOAKS BLVD STE 101C
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91201-1978
Practice Address - Country:US
Practice Address - Phone:205-282-9136
Practice Address - Fax:205-974-3248
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-16
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health