Healthcare Provider Details

I. General information

NPI: 1174744833
Provider Name (Legal Business Name): BURBANK ADHC INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 08/21/2023
Certification Date: 08/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2609 W BURBANK BLVD
BURBANK CA
91505-2304
US

IV. Provider business mailing address

2609 W BURBANK BLVD
BURBANK CA
91505-2304
US

V. Phone/Fax

Practice location:
  • Phone: 818-563-9255
  • Fax: 818-563-9265
Mailing address:
  • Phone: 818-563-9255
  • Fax: 818-563-9265

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number46807244
License Number StateCA

VIII. Authorized Official

Name: SOUREN BASMADJIAN
Title or Position: PRESIDENT
Credential:
Phone: 818-563-9255