Provider Demographics
NPI:1235898727
Name:SKY LIGHT RESIDENTIAL CARE
Entity Type:Organization
Organization Name:SKY LIGHT RESIDENTIAL CARE
Other - Org Name:SKY LIGHT RESIDENTIAL CARE
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO/ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARO
Authorized Official - Middle Name:
Authorized Official - Last Name:PODRUMYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:424-335-5222
Mailing Address - Street 1:19856 MAYALL ST
Mailing Address - Street 2:
Mailing Address - City:CHATSWORTH
Mailing Address - State:CA
Mailing Address - Zip Code:91311-3521
Mailing Address - Country:US
Mailing Address - Phone:142-433-5522
Mailing Address - Fax:
Practice Address - Street 1:19856 MAYALL ST
Practice Address - Street 2:
Practice Address - City:CHATSWORTH
Practice Address - State:CA
Practice Address - Zip Code:91311-3521
Practice Address - Country:US
Practice Address - Phone:142-433-5522
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-11
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility