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General NPI Number Information
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NPI Number | 1720857766
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Entity Type | Organization
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Legal Business Name | QUEEN OF ANGELS RESIDENTIAL CARE FACILITY
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Dates
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Enumeration Date | 01/01/2024
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Last Update Date | 01/01/2024
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Provider Practice Location Address
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Address Line | 9514 RUBIO AVE
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City | NORTHRIDGE
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State | CA
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Zip | 91343-2614
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Country | US
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Telephone | 323-684-1609
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Fax |
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Provider Business Mailing Address
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Address Line | 6621 TEESDALE AVE
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City | NORTH HOLLYWOOD
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State | CA
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Zip | 91606-1209
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Country | US
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Telephone | 323-684-1609
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | SONA AYRAPETYAN
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Credential |
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Telephone | 323-684-1609
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310500000X
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Taxonomy Name | Mental Illness Intermediate Care Facility
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License Number |
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License Number State |
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