Provider Demographics
NPI:1073736427
Name:RAZAVI CORP
Entity Type:Organization
Organization Name:RAZAVI CORP
Other - Org Name:HILLDALE HABILITATION CENETR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DARIUSH
Authorized Official - Middle Name:
Authorized Official - Last Name:RAZAVI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-465-8010
Mailing Address - Street 1:7979 LA MESA BLVD
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91941-5065
Mailing Address - Country:US
Mailing Address - Phone:619-465-8010
Mailing Address - Fax:619-465-8348
Practice Address - Street 1:7979 LA MESA BLVD
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91941-5065
Practice Address - Country:US
Practice Address - Phone:619-465-8010
Practice Address - Fax:619-465-8348
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities