Healthcare Provider Details

I. General information

NPI: 1477206621
Provider Name (Legal Business Name): SPRINGVILLE RANCH ADHC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2022
Last Update Date: 01/28/2022
Certification Date: 01/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36400 CA-190
SPRINGVILLE CA
93265
US

IV. Provider business mailing address

416 ETON DR
BURBANK CA
91504-2942
US

V. Phone/Fax

Practice location:
  • Phone: 818-371-7611
  • Fax:
Mailing address:
  • Phone: 818-371-7611
  • 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: ARTUR ARSENYAN
Title or Position: BOARD MEMBR
Credential:
Phone: 818-371-7611