MEDICARE: BLUE CROSS ELDERLY CARE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1063192219
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLUE CROSS ELDERLY CARE

Provider Business Mailing Address
First Line	:	7747 VAN NOORD AVE
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91605-1934
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7915 VAN NOORD AVE
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91605-1944
Country	:	US
Telephone Number	:	323-688-3377
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	ANNA ATAYAN
Credential	:
Telephone Number	:	323-688-3377

Provider Enumeration Date	:	07/21/2023
Last Update Date	:	10/16/2023

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