Provider Demographics
NPI:1497426654
Name:AMADA HEALTH GHALCHI
Entity Type:Organization
Organization Name:AMADA HEALTH GHALCHI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PARVIZ
Authorized Official - Middle Name:S
Authorized Official - Last Name:SHOUR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-613-6789
Mailing Address - Street 1:820 N WHITTIER DR
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-3044
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12424 WILSHIRE BLVD FL 12
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-1052
Practice Address - Country:US
Practice Address - Phone:818-613-6789
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-27
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization