Provider Demographics
NPI:1003875493
Name:HEALTHYLIFE,INC
Entity Type:Organization
Organization Name:HEALTHYLIFE,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:VARDUHI
Authorized Official - Middle Name:
Authorized Official - Last Name:BABAYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-637-9700
Mailing Address - Street 1:11613 W WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90066-5915
Mailing Address - Country:US
Mailing Address - Phone:213-637-9700
Mailing Address - Fax:213-637-9705
Practice Address - Street 1:11613 W WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90066-5915
Practice Address - Country:US
Practice Address - Phone:213-637-9700
Practice Address - Fax:213-637-9705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-22
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA060000682251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAADU70166FMedicaid