Healthcare Provider Details

I. General information

NPI: 1942414990
Provider Name (Legal Business Name): GRAND ADULT HEALTH DAY CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6752 WHITE OAK AVENUE
VAN NUYS CA
91406
US

IV. Provider business mailing address

6752 WHITE OAK AVENUE
VAN NUYS CA
91406
US

V. Phone/Fax

Practice location:
  • Phone: 818-344-3456
  • Fax: 818-344-3321
Mailing address:
  • Phone: 818-344-3456
  • Fax: 818-344-3321

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number StateCA

VIII. Authorized Official

Name: SIMON POGOSSIAN
Title or Position: PRESIDENT
Credential:
Phone: 818-344-3456