Healthcare Provider Details

I. General information

NPI: 1215446109
Provider Name (Legal Business Name): WELLBE HOME INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2017
Last Update Date: 12/30/2024
Certification Date: 12/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12950 HAYNES ST
NORTH HOLLYWOOD CA
91606-1022
US

IV. Provider business mailing address

6325 BEEMAN AVE
NORTH HOLLYWOOD CA
91606-3122
US

V. Phone/Fax

Practice location:
  • Phone: 818-414-0005
  • Fax: 855-683-8256
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number197609307
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number
License Number State

VIII. Authorized Official

Name: VAHE MKRTCHIAN
Title or Position: ADMINISTRATOR
Credential:
Phone: 818-414-0005