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General NPI Number Information
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NPI Number | 1679118475
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Entity Type | Organization
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Legal Business Name | HEAVENLY ADHC, INC.
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Dates
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Enumeration Date | 11/15/2019
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Last Update Date | 02/25/2025
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Provider Practice Location Address
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Address Line | 4777 SANTA MONICA BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90029
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Country | US
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Telephone | 323-646-6929
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Fax | 213-402-2005
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Provider Business Mailing Address
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Address Line | 4506 KINGSWELL AVE
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City | LOS ANGELES
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State | CA
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Zip | 90027
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Country | US
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Telephone | 323-646-6929
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Fax | 213-402-2005
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Authorized Official
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Title or Position | CEO
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Name | CHRISTINA KIRIKIAN
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Credential |
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Telephone | 323-646-6929
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number |
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License Number State |
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