Healthcare Provider Details

I. General information

NPI: 1548755184
Provider Name (Legal Business Name): VATICAN ADULT DAY CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2018
Last Update Date: 06/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6913 VAN NUYS BLVD
VAN NUYS CA
91405-3936
US

IV. Provider business mailing address

6913 VAN NUYS BLVD
VAN NUYS CA
91405-3936
US

V. Phone/Fax

Practice location:
  • Phone: 818-691-5252
  • Fax: 818-500-0779
Mailing address:
  • Phone: 818-691-5252
  • Fax: 818-500-0779

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number StateCA

VIII. Authorized Official

Name: LUSINE NALBANDYAN
Title or Position: PROGRAM DIRECTOR
Credential:
Phone: 818-687-5175