MEDICARE: DIANA'S GARDEN ELDERLY CARE

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	302R00000X	Health Maintenance Organization	197608572	CA

General Provider Information

NPI Number	:	1760807762
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIANA'S GARDEN ELDERLY CARE

Provider Business Mailing Address
First Line	:	6507 BABCOCK AVE
Second Line	:
City	:	N HOLLYWOOD
State	:	CA
Zip	:	91606-2308
Country	:	US
Telephone Number	:	213-446-0920
Fax Number	:

Provider Business Practice Location Address
First Line	:	6507 BABCOCK AVE
Second Line	:
City	:	N HOLLYWOOD
State	:	CA
Zip	:	91606-2308
Country	:	US
Telephone Number	:	213-446-0920
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. ANNA HAKOBYAN
Credential	:
Telephone Number	:	213-446-0920

Provider Enumeration Date	:	02/27/2014
Last Update Date	:	02/27/2014

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