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General NPI Number Information
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NPI Number | 1760915391
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Entity Type | Organization
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Legal Business Name | IMPERIUMSENIORLIVINGLLC
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Dates
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Enumeration Date | 04/11/2017
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Last Update Date | 04/11/2017
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Provider Practice Location Address
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Address Line | 5236 OTIS AVE
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City | TARZANA
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State | CA
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Zip | 91356-4212
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Country | US
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Telephone | 818-731-6635
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Fax |
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Provider Business Mailing Address
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Address Line | 5236 OTIS AVE
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City | TARZANA
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State | CA
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Zip | 91356-4212
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Country | US
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Telephone | 818-731-6635
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. SARGIS AYVAZYAN
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Credential |
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Telephone | 818-731-6635
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 197608866
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License Number State | CA
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