MEDICARE: MONOGRAM VILLA INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1174487730
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MONOGRAM VILLA INC.

Provider Business Mailing Address
First Line	:	5536 TYRONE AVE
Second Line	:
City	:	SHERMAN OAKS
State	:	CA
Zip	:	91401-5126
Country	:	US
Telephone Number	:	833-466-6647
Fax Number	:

Provider Business Practice Location Address
First Line	:	5536 TYRONE AVE
Second Line	:
City	:	SHERMAN OAKS
State	:	CA
Zip	:	91401-5126
Country	:	US
Telephone Number	:	866-466-6647
Fax Number	:

Authorized Official
Title or Position	:	LICENSEE
Name	:	AZNIV ANGELA KRBASHYAN
Credential	:
Telephone Number	:	833-466-6647

Provider Enumeration Date	:	12/09/2025
Last Update Date	:	12/09/2025

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