Provider Demographics
NPI:1689150856
Name:PROVIDENCE ADHC CENETR, INC.
Entity Type:Organization
Organization Name:PROVIDENCE ADHC CENETR, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANOUCH
Authorized Official - Middle Name:
Authorized Official - Last Name:AIRAPETIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-781-7898
Mailing Address - Street 1:6931 ATOLL AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91605-4725
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6931 ATOLL AVE
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91605-4725
Practice Address - Country:US
Practice Address - Phone:818-781-7898
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-11
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care