Provider Demographics
NPI:1619435773
Name:PRISM HEALTHCARE, INC.
Entity Type:Organization
Organization Name:PRISM HEALTHCARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:HOVIK
Authorized Official - Middle Name:
Authorized Official - Last Name:GABRIELYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-442-3085
Mailing Address - Street 1:23928 JENSEN DR
Mailing Address - Street 2:
Mailing Address - City:WEST HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91304-3009
Mailing Address - Country:US
Mailing Address - Phone:818-298-1128
Mailing Address - Fax:
Practice Address - Street 1:21600 OXNARD ST STE 1030
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91367-5085
Practice Address - Country:US
Practice Address - Phone:818-318-0898
Practice Address - Fax:818-457-4617
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-07
Last Update Date:2019-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health