Provider Demographics
NPI:1114996154
Name:HOLLYWOOD HEALTH SYSTEM INC
Entity Type:Organization
Organization Name:HOLLYWOOD HEALTH SYSTEM INC
Other - Org Name:HOLLYWOOD HOME HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GRIGOR
Authorized Official - Middle Name:
Authorized Official - Last Name:ADAMYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-399-7777
Mailing Address - Street 1:4640 LANKERSHIM BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91602-1845
Mailing Address - Country:US
Mailing Address - Phone:323-662-3731
Mailing Address - Fax:323-662-3751
Practice Address - Street 1:4640 LANKERSHIM BLVD STE 100
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91602-1845
Practice Address - Country:US
Practice Address - Phone:323-662-3731
Practice Address - Fax:323-662-3751
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-14
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA980001532251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHHA08310FMedicaid
CAHHA08310FMedicaid