Healthcare Provider Details

I. General information

NPI: 1437834967
Provider Name (Legal Business Name): SILVER WISDOM HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2023
Last Update Date: 01/30/2025
Certification Date: 01/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1714 IVAR AVE UNIT D
LOS ANGELES CA
90028-5124
US

IV. Provider business mailing address

1714 IVAR AVE UNIT D
LOS ANGELES CA
90028-5124
US

V. Phone/Fax

Practice location:
  • Phone: 323-464-9161
  • Fax: 323-464-9166
Mailing address:
  • Phone: 323-464-9161
  • Fax: 323-464-9166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code332U00000X
TaxonomyHome Delivered Meals
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: ANNA HARTUNIAN
Title or Position: ECM DIRECTOR
Credential:
Phone: 818-404-7555