Provider Demographics
NPI:1760807762
Name:DIANA'S GARDEN ELDERLY CARE
Entity Type:Organization
Organization Name:DIANA'S GARDEN ELDERLY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:HAKOBYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-446-0920
Mailing Address - Street 1:6507 BABCOCK AVE
Mailing Address - Street 2:
Mailing Address - City:N HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91606-2308
Mailing Address - Country:US
Mailing Address - Phone:213-446-0920
Mailing Address - Fax:
Practice Address - Street 1:6507 BABCOCK AVE
Practice Address - Street 2:
Practice Address - City:N HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91606-2308
Practice Address - Country:US
Practice Address - Phone:213-446-0920
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-27
Last Update Date:2014-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA197608572302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization