=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437834967
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SILVER WISDOM HEALTHCARE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/21/2023
-----------------------------------------------------
Last Update Date | 01/30/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1714 IVAR AVE UNIT D
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90028-5124
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-464-9161
-----------------------------------------------------
Fax | 323-464-9166
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1714 IVAR AVE UNIT D
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90028-5124
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-464-9161
-----------------------------------------------------
Fax | 323-464-9166
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ECM DIRECTOR
-----------------------------------------------------
Name | ANNA HARTUNIAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 818-404-7555
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171M00000X
-----------------------------------------------------
Taxonomy Name | Case Manager/Care Coordinator
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 251X00000X
-----------------------------------------------------
Taxonomy Name | Supports Brokerage Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 332U00000X
-----------------------------------------------------
Taxonomy Name | Home Delivered Meals
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 261QA0600X
-----------------------------------------------------
Taxonomy Name | Adult Day Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------