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General NPI Number Information
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NPI Number | 1053015156
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Entity Type | Organization
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Legal Business Name | HEAVENLY CASTLE CARE INC
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Dates
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Enumeration Date | 03/30/2023
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Last Update Date | 03/30/2023
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Provider Practice Location Address
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Address Line | 1651 WHITE ROCK RD
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City | FRAZIER PARK
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State | CA
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Zip | 93225-9588
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Country | US
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Telephone | 310-993-2447
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Fax |
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Provider Business Mailing Address
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Address Line | 1651 WHITE ROCK RD
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City | FRAZIER PARK
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State | CA
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Zip | 93225-9588
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Country | US
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Telephone | 310-993-2447
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LYUSYA NSHANYAN
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Credential |
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Telephone | 310-993-2447
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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