Healthcare Provider Details

I. General information

NPI: 1417603986
Provider Name (Legal Business Name): LILY GARDEN HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2022
Last Update Date: 02/23/2022
Certification Date: 02/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 S CENTRAL AVE STE 15
GLENDALE CA
91204-2084
US

IV. Provider business mailing address

815 S CENTRAL AVE STE 15
GLENDALE CA
91204-2084
US

V. Phone/Fax

Practice location:
  • Phone: 818-484-5183
  • Fax: 818-484-5185
Mailing address:
  • Phone: 818-484-5183
  • Fax: 818-484-5185

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: SARKIS MINASYAN
Title or Position: CFO,CEO,SECRETARY
Credential:
Phone: 818-484-5183