Provider Demographics
NPI:1609637313
Name:HOLLYWOOD HEALTHY LIVING LLC
Entity Type:Organization
Organization Name:HOLLYWOOD HEALTHY LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSEE
Authorized Official - Prefix:
Authorized Official - First Name:GAYANE
Authorized Official - Middle Name:
Authorized Official - Last Name:AGAZARYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-395-1905
Mailing Address - Street 1:8002 HOLLYWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:SUN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91352-4225
Mailing Address - Country:US
Mailing Address - Phone:818-395-1905
Mailing Address - Fax:
Practice Address - Street 1:8002 HOLLYWOOD WAY
Practice Address - Street 2:
Practice Address - City:SUN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:91352-4225
Practice Address - Country:US
Practice Address - Phone:818-395-1905
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-19
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility