Healthcare Provider Details

I. General information

NPI: 1679118475
Provider Name (Legal Business Name): HEAVENLY ADHC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2019
Last Update Date: 02/25/2025
Certification Date: 02/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4777 SANTA MONICA BLVD
LOS ANGELES CA
90029
US

IV. Provider business mailing address

4506 KINGSWELL AVE
LOS ANGELES CA
90027
US

V. Phone/Fax

Practice location:
  • Phone: 323-646-6929
  • Fax: 213-402-2005
Mailing address:
  • Phone: 323-646-6929
  • Fax: 213-402-2005

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: CHRISTINA KIRIKIAN
Title or Position: CEO
Credential:
Phone: 323-646-6929