Healthcare Provider Details

I. General information

NPI: 1013571710
Provider Name (Legal Business Name): ST. ANTHONY'S ADHC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2019
Last Update Date: 04/19/2022
Certification Date: 04/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13765 VAN NUYS BLVD
PACOIMA CA
91331-3621
US

IV. Provider business mailing address

13765 VAN NUYS BLVD
PACOIMA CA
91331-3621
US

V. Phone/Fax

Practice location:
  • Phone: 818-512-7340
  • 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: INGA PAMBUKYAN
Title or Position: CEO
Credential:
Phone: 818-686-2127