Healthcare Provider Details

I. General information

NPI: 1154839264
Provider Name (Legal Business Name): ELITE CBAS CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2018
Last Update Date: 06/10/2021
Certification Date: 06/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12825 VANOWEN ST
NORTH HOLLYWOOD CA
91605-5219
US

IV. Provider business mailing address

12825 VANOWEN ST
NORTH HOLLYWOOD CA
91605-5219
US

V. Phone/Fax

Practice location:
  • Phone: 818-927-4344
  • Fax: 818-927-4345
Mailing address:
  • Phone: 818-924-4344
  • Fax: 818-927-4345

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: KHOREN DICHIGRIKIAN
Title or Position: CEO
Credential:
Phone: 818-927-4344