Provider Demographics
NPI:1477555472
Name:ARARAT HOME OF LOS ANGELES INC.
Entity Type:Organization
Organization Name:ARARAT HOME OF LOS ANGELES INC.
Other - Org Name:ARARAT NURSING FACILITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARGARITA
Authorized Official - Middle Name:
Authorized Official - Last Name:KECHECHIAN
Authorized Official - Suffix:
Authorized Official - Credentials:NHA
Authorized Official - Phone:818-837-1800
Mailing Address - Street 1:15099 MISSION HILLS RD
Mailing Address - Street 2:
Mailing Address - City:MISSION HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91345-1102
Mailing Address - Country:US
Mailing Address - Phone:818-837-1800
Mailing Address - Fax:818-898-2224
Practice Address - Street 1:15099 MISSION HILLS RD
Practice Address - Street 2:
Practice Address - City:MISSION HILLS
Practice Address - State:CA
Practice Address - Zip Code:91345-1102
Practice Address - Country:US
Practice Address - Phone:818-837-1800
Practice Address - Fax:818-898-2224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-10
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA920000124314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA555579FMedicaid
CA55579FMedicaid
CA555579Medicare PIN
CA55579FMedicaid