MEDICARE: HEAVENLY MANOR 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	261QR0800X	Recovery Care Clinic/Center

General Provider Information

NPI Number	:	1750101184
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEAVENLY MANOR INC

Provider Business Mailing Address
First Line	:	9742 HASKELL AVE
Second Line	:
City	:	NORTH HILLS
State	:	CA
Zip	:	91343-2017
Country	:	US
Telephone Number	:	818-653-6440
Fax Number	:

Provider Business Practice Location Address
First Line	:	9742 HASKELL AVE
Second Line	:
City	:	NORTH HILLS
State	:	CA
Zip	:	91343-2017
Country	:	US
Telephone Number	:	818-653-6440
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. STEPAN STEVE AMIRIAN
Credential	:
Telephone Number	:	818-653-6440

Provider Enumeration Date	:	10/11/2024
Last Update Date	:	10/11/2024

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Directions to “HEAVENLY MANOR INC ” Practice Location

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