Healthcare Provider Details

I. General information

NPI: 1942804521
Provider Name (Legal Business Name): SAMPEAH GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2020
Last Update Date: 11/24/2020
Certification Date: 11/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1307 W 6TH ST # 123-126
CORONA CA
92882-3294
US

IV. Provider business mailing address

348 E OLIVE AVE STE J
BURBANK CA
91502-1226
US

V. Phone/Fax

Practice location:
  • Phone: 951-523-8081
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierC4169124
Identifier TypeOTHER
Identifier State
Identifier IssuerCALIFORNIA CORPORATION

VIII. Authorized Official

Name: CHRISTINE KHATCHOYAN
Title or Position: ADMINISTRATOR
Credential:
Phone: 818-941-5942