Healthcare Provider Details

I. General information

NPI: 1699156331
Provider Name (Legal Business Name): OAKRIDGE INN RCFE LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2015
Last Update Date: 06/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1281 OAKRIDGE DR
GLENDALE CA
91205-3412
US

IV. Provider business mailing address

1281 OAKRIDGE DR
GLENDALE CA
91205-3412
US

V. Phone/Fax

Practice location:
  • Phone: 818-482-9117
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0005X
TaxonomyAmbulatory Family Planning Facility
License Number
License Number State

VIII. Authorized Official

Name: KHACHIK PETROSYAN
Title or Position: OWNER
Credential:
Phone: 818-482-9117