Healthcare Provider Details

I. General information

NPI: 1104438977
Provider Name (Legal Business Name): ERMANITA CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2020
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17441 DEVONSHIRE ST
NORTHRIDGE CA
91325-1544
US

IV. Provider business mailing address

17441 DEVONSHIRE ST
NORTHRIDGE CA
91325-1544
US

V. Phone/Fax

Practice location:
  • Phone: 310-955-8213
  • Fax:
Mailing address:
  • Phone: 310-955-8213
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: FARAH BANGASH
Title or Position: ADMINISTRATOR, OWNER
Credential: MBBS
Phone: 310-955-8213