Healthcare Provider Details

I. General information

NPI: 1780118554
Provider Name (Legal Business Name): ADASTRA HEALTH CARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2017
Last Update Date: 02/13/2020
Certification Date: 02/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20453 ELKWOOD ST.
WINNETKA CA
91306-2233
US

IV. Provider business mailing address

20453 ELKWOOD ST.
WINNETKA CA
91306-2233
US

V. Phone/Fax

Practice location:
  • Phone: 818-993-1440
  • Fax: 818-993-1449
Mailing address:
  • Phone: 818-993-1440
  • Fax: 818-993-1449

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number550003791
License Number StateCA

VIII. Authorized Official

Name: MS. SUSANNA ARAKELYAN
Title or Position: CEO, PRESIDENT
Credential:
Phone: 818-993-1440