Healthcare Provider Details

I. General information

NPI: 1508727801
Provider Name (Legal Business Name): LAVENDER ADULT DAY HEALTH CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2025
Last Update Date: 11/18/2025
Certification Date: 11/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

609 N POPLAR AVE
MONTEBELLO CA
90640-3558
US

IV. Provider business mailing address

609 N POPLAR AVE
MONTEBELLO CA
90640-3558
US

V. Phone/Fax

Practice location:
  • Phone: 323-306-6300
  • Fax: 323-306-6302
Mailing address:
  • Phone: 323-306-6300
  • Fax: 323-306-6302

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: HRAG HARBOYAN
Title or Position: OWNER
Credential:
Phone: 323-303-7890