Provider Demographics
NPI:1407584840
Name:GRANT SERENITY HOMES OF BURBANK, INC.
Entity Type:Organization
Organization Name:GRANT SERENITY HOMES OF BURBANK, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NVARD
Authorized Official - Middle Name:
Authorized Official - Last Name:GEVORKIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-425-6797
Mailing Address - Street 1:436 N REESE PL
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91506-1957
Mailing Address - Country:US
Mailing Address - Phone:818-433-7704
Mailing Address - Fax:
Practice Address - Street 1:436 N REESE PL
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91506-1957
Practice Address - Country:US
Practice Address - Phone:818-433-7704
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-12
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility