Provider Demographics
NPI:1356094643
Name:FULLY WELL HEALTHCARE
Entity Type:Organization
Organization Name:FULLY WELL HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ARMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:AVETISYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-945-1599
Mailing Address - Street 1:5535 BALBOA BLVD STE 204B
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-1516
Mailing Address - Country:US
Mailing Address - Phone:818-945-1599
Mailing Address - Fax:818-864-3218
Practice Address - Street 1:5535 BALBOA BLVD STE 204B
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-1516
Practice Address - Country:US
Practice Address - Phone:818-945-1599
Practice Address - Fax:818-864-3218
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-27
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health