Healthcare Provider Details

I. General information

NPI: 1780904730
Provider Name (Legal Business Name): LOVE-IN-HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2010
Last Update Date: 06/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1603 NEW YORK DR
ALTADENA CA
91001-3237
US

IV. Provider business mailing address

1603 NEW YORK DR
ALTADENA CA
91001-3237
US

V. Phone/Fax

Practice location:
  • Phone: 626-529-5651
  • Fax: 626-529-5663
Mailing address:
  • Phone: 626-529-5651
  • Fax: 626-529-5663

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number197607417
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code310500000X
TaxonomyMental Illness Intermediate Care Facility
License Number197607417
License Number StateCA

VIII. Authorized Official

Name: DR. ASYA ESTE BABAJANYAN
Title or Position: ADMINISTRATOR
Credential:
Phone: 626-529-5651