1124505797 NPI number — DISTINGUISHED CARE HOME HEALTH, INC.

Table of content: TIFFANY JAYNE GALUSH PA (NPI 1942867692)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124505797 NPI number — DISTINGUISHED CARE HOME HEALTH, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DISTINGUISHED CARE HOME HEALTH, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1124505797
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/08/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
229 N CENTRAL AVE STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GLENDALE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91203-3555
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-523-2494
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
229 N CENTRAL AVE STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GLENDALE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91203-3555
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-523-2494
Provider Business Practice Location Address Fax Number:
818-396-4235
Provider Enumeration Date:
07/25/2018

Additional Information

Authorized Official

Authorized Official Last Name:
RAJABOV
Authorized Official First Name:
MATIN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT/CEO
Authorized Official Telephone Number:
818-484-7262

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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