=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194477893
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VALLEY PARADISE CBAS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/24/2022
-----------------------------------------------------
Last Update Date | 05/21/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 31905 CASTAIC RD
-----------------------------------------------------
City | CASTAIC
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91384-3982
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-616-7027
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 31905 CASTAIC RD
-----------------------------------------------------
City | CASTAIC
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91384-3982
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-616-7027
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | KRISTINE CHILINGIRIAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 213-261-9595
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QA0600X
-----------------------------------------------------
Taxonomy Name | Adult Day Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------