Provider Demographics
NPI:1326595117
Name:VANIK & ARSEN LLC
Entity Type:Organization
Organization Name:VANIK & ARSEN LLC
Other - Org Name:GRAND VILLA CONGREGATE LIVING HEALTH FACILITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:VANIK
Authorized Official - Middle Name:
Authorized Official - Last Name:POGOSYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-273-1706
Mailing Address - Street 1:2484 E GETTYSBURG AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93726-0322
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:250 VILLA AVE
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93612-0854
Practice Address - Country:US
Practice Address - Phone:559-273-1706
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-08
Last Update Date:2019-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA310400000X, 314000000X, 320700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities