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General NPI Number Information
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NPI Number | 1750101184
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Entity Type | Organization
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Legal Business Name | HEAVENLY MANOR INC
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Dates
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Enumeration Date | 10/11/2024
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Last Update Date | 10/11/2024
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Provider Practice Location Address
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Address Line | 9742 HASKELL AVE
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City | NORTH HILLS
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State | CA
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Zip | 91343-2017
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Country | US
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Telephone | 818-653-6440
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Fax |
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Provider Business Mailing Address
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Address Line | 9742 HASKELL AVE
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City | NORTH HILLS
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State | CA
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Zip | 91343-2017
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Country | US
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Telephone | 818-653-6440
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. STEPAN STEVE AMIRIAN
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Credential |
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Telephone | 818-653-6440
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0800X
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Taxonomy Name | Recovery Care Clinic/Center
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License Number |
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License Number State |
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