Healthcare Provider Details

I. General information

NPI: 1285073007
Provider Name (Legal Business Name): LA TUNA HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2013
Last Update Date: 06/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10109 LA TUNA CANYON RD
SUN VALLEY CA
91352-2102
US

IV. Provider business mailing address

10109 LA TUNA CANYON RD
SUN VALLEY CA
91352-2102
US

V. Phone/Fax

Practice location:
  • Phone: 818-394-9950
  • Fax: 818-394-9452
Mailing address:
  • Phone: 818-394-9950
  • Fax: 818-394-9452

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number550002271
License Number StateCA

VIII. Authorized Official

Name: MRS. LALA BAYANDURYAN
Title or Position: DPCS/ADMINISTRATOR
Credential: RN
Phone: 818-394-9950