MEDICARE: LA WELLNESS HOME 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	324500000X	Substance Abuse Rehabilitation Facility

General Provider Information

NPI Number	:	1801518956
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LA WELLNESS HOME INC.

Provider Business Mailing Address
First Line	:	2428 N LINCOLN ST
Second Line	:
City	:	BURBANK
State	:	CA
Zip	:	91504-2627
Country	:	US
Telephone Number	:	818-808-0108
Fax Number	:	323-892-3866

Provider Business Practice Location Address
First Line	:	2428 N LINCOLN ST
Second Line	:
City	:	BURBANK
State	:	CA
Zip	:	91504-2627
Country	:	US
Telephone Number	:	818-808-0108
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MR. ISHKHAN SHAHAZIZYAN
Credential	:
Telephone Number	:	818-808-0108

Provider Enumeration Date	:	09/15/2022
Last Update Date	:	10/04/2024

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Directions to “LA WELLNESS HOME INC. ” Practice Location

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