Provider Demographics
NPI:1164788592
Name:CAROLINE IN HEAVEN LLC
Entity Type:Organization
Organization Name:CAROLINE IN HEAVEN LLC
Other - Org Name:CAROLINE'S CHATEAU
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR/LICENSEE
Authorized Official - Prefix:MRS
Authorized Official - First Name:VIRGINIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIROSSIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-361-0880
Mailing Address - Street 1:14132 HUBBARD ST
Mailing Address - Street 2:
Mailing Address - City:SYLMAR
Mailing Address - State:CA
Mailing Address - Zip Code:91342-4712
Mailing Address - Country:US
Mailing Address - Phone:818-361-0880
Mailing Address - Fax:818-361-0256
Practice Address - Street 1:14132 HUBBARD ST
Practice Address - Street 2:
Practice Address - City:SYLMAR
Practice Address - State:CA
Practice Address - Zip Code:91342-4712
Practice Address - Country:US
Practice Address - Phone:818-361-0880
Practice Address - Fax:818-361-0256
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-10
Last Update Date:2012-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA197608006310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility