Healthcare Provider Details

I. General information

NPI: 1689150856
Provider Name (Legal Business Name): PROVIDENCE ADHC CENETR, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2018
Last Update Date: 07/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6931 ATOLL AVE
NORTH HOLLYWOOD CA
91605-4725
US

IV. Provider business mailing address

6931 ATOLL AVE
NORTH HOLLYWOOD CA
91605-4725
US

V. Phone/Fax

Practice location:
  • Phone: 818-781-7898
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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: ANOUCH AIRAPETIAN
Title or Position: CEO
Credential:
Phone: 818-781-7898