Healthcare Provider Details

I. General information

NPI: 1922534916
Provider Name (Legal Business Name): WELL CARE CONGREGATE LIVING HEALTH FACILITY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2017
Last Update Date: 05/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14926 VOSE ST.
VAN NUYS CA
91405
US

IV. Provider business mailing address

14926 VOSE ST.
VAN NUYS CA
91405
US

V. Phone/Fax

Practice location:
  • Phone: 818-646-1138
  • Fax: 818-646-1139
Mailing address:
  • Phone: 818-646-1138
  • Fax: 818-646-1139

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. OGANES AZATYAN
Title or Position: CEO
Credential:
Phone: 818-646-1138