Provider Demographics
NPI:1003958356
Name:ARARAT HOME OF LOS ANGELES, INC.
Entity Type:Organization
Organization Name:ARARAT HOME OF LOS ANGELES, INC.
Other - Org Name:ARARAT CONVALESCENT HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:DERIK
Authorized Official - Middle Name:
Authorized Official - Last Name:GHOOKASIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-256-8012
Mailing Address - Street 1:2373 COLORADO BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90041-1157
Mailing Address - Country:US
Mailing Address - Phone:323-256-8012
Mailing Address - Fax:323-256-8146
Practice Address - Street 1:2373 COLORADO BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90041-1157
Practice Address - Country:US
Practice Address - Phone:323-256-8012
Practice Address - Fax:323-256-8146
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA970000045314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALTC55126FMedicaid
CA555126Medicare ID - Type UnspecifiedPROVIDER NUMBER