MEDICARE: SILVER WISDOM ADULT DAY HEALTHCARE CENTER, 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	171M00000X	Case Manager/Care Coordinator
2	261QA0600X	Adult Day Care Clinic/Center	060000816	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	ADU70314F	OTHER	CA	MEDI-CAL PROVIDER NUMBER

General Provider Information

NPI Number	:	1841406436
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SILVER WISDOM ADULT DAY HEALTHCARE CENTER, INC.

Provider Business Mailing Address
First Line	:	1714 IVAR AVE
Second Line	:
City	:	HOLLYWOOD
State	:	CA
Zip	:	90028-5124
Country	:	US
Telephone Number	:	323-464-9161
Fax Number	:	323-464-9166

Provider Business Practice Location Address
First Line	:	1714 IVAR AVE STE A
Second Line	:
City	:	HOLLYWOOD
State	:	CA
Zip	:	90028-5155
Country	:	US
Telephone Number	:	323-464-9161
Fax Number	:	323-464-9166

Authorized Official
Title or Position	:	CEO
Name	:	MR. TIGRAN TIKO OHANIAN
Credential	:
Telephone Number	:	323-464-9161

Provider Enumeration Date	:	05/14/2007
Last Update Date	:	07/18/2025

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