MEDICARE: FAMILY CARE CLHF, INC.

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	314000000X	Skilled Nursing Facility

General Provider Information

NPI Number	:	1568929891
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY CARE CLHF, INC.

Provider Business Mailing Address
First Line	:	1412 CLEVELAND RD
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91202-1415
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1412 CLEVELAND RD
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91202-1415
Country	:	US
Telephone Number	:	818-489-0062
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	ANI ARSENYAN
Credential	:
Telephone Number	:	818-489-0062

Provider Enumeration Date	:	02/22/2019
Last Update Date	:	04/13/2020

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