Healthcare Provider Details

I. General information

NPI: 1003958356
Provider Name (Legal Business Name): ARARAT HOME OF LOS ANGELES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 07/29/2022
Certification Date: 07/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2373 COLORADO BLVD
LOS ANGELES CA
90041-1157
US

IV. Provider business mailing address

2373 COLORADO BLVD
LOS ANGELES CA
90041-1157
US

V. Phone/Fax

Practice location:
  • Phone: 323-256-8012
  • Fax: 323-256-8146
Mailing address:
  • Phone: 323-256-8012
  • Fax: 323-256-8146

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number970000045
License Number StateCA

VIII. Authorized Official

Name: MR. DERIK GHOOKASIAN
Title or Position: COO
Credential:
Phone: 323-256-8012