Healthcare Provider Details

I. General information

NPI: 1679201016
Provider Name (Legal Business Name): GRANT SERENITY HOMES OF SIERRA MADRE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2022
Last Update Date: 08/12/2022
Certification Date: 08/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 N SIERRA MADRE BLVD
PASADENA CA
91107-2859
US

IV. Provider business mailing address

425 N SIERRA MADRE BLVD
PASADENA CA
91107-2859
US

V. Phone/Fax

Practice location:
  • Phone: 818-433-7704
  • Fax:
Mailing address:
  • Phone: 818-433-7704
  • 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: NVARD GEVORKIAN
Title or Position: OWNER
Credential:
Phone: 818-425-6797