Healthcare Provider Details

I. General information

NPI: 1447717574
Provider Name (Legal Business Name): DIVINE ADULT DAY HEALTH CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2019
Last Update Date: 03/15/2022
Certification Date: 03/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6650 VAN NUYS BLVD
VAN NUYS CA
91405-4617
US

IV. Provider business mailing address

6650 VAN NUYS BLVD
VAN NUYS CA
91405-4617
US

V. Phone/Fax

Practice location:
  • Phone: 747-250-7305
  • Fax: 747-208-2750
Mailing address:
  • Phone: 747-250-7305
  • Fax: 747-208-2750

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: HAKOP JACK ZAKARYAN
Title or Position: PRESIDENT
Credential:
Phone: 747-250-7305