Healthcare Provider Details

I. General information

NPI: 1164291357
Provider Name (Legal Business Name): SHINING STAR ADHC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2023
Last Update Date: 12/28/2023
Certification Date: 12/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 COLORADO BLVD
LOS ANGELES CA
90041-1340
US

IV. Provider business mailing address

1800 COLORADO BLVD
LOS ANGELES CA
90041-1340
US

V. Phone/Fax

Practice location:
  • Phone: 213-927-4131
  • Fax: 213-402-6448
Mailing address:
  • Phone: 213-927-4131
  • Fax: 213-402-6448

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ARMEN BASMADZHYAN
Title or Position: ADMINISTRATOR
Credential:
Phone: 213-927-4131