# LAKE HOME HEALTH

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1659025575
- **Authorized official:** NAIRA DADYAN (OWNER)
- **Authorized official phone:** (747) 264-0421

## Contact information

- **Practice address:** 6360 VAN NUYS BLVD STE 167, VAN NUYS, CA 91401-6657
- **Practice address phone:** (747) 264-0421
- **Practice address fax:** (747) 264-0422
- **Mailing address:** 6360 VAN NUYS BLVD STE 167, VAN NUYS, CA 91401-6657
- **Mailing address phone:** (747) 264-0421
- **Mailing address fax:** (747) 264-0422

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251E00000X | Home Health Agency | — | NULL | Yes |

## Other

- **Enumeration date:** 02/09/2022
- **Last updated:** 02/09/2022