Provider Demographics
NPI:1770256273
Name:CSGB HEALTHCARE, LLC
Entity Type:Organization
Organization Name:CSGB HEALTHCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:GEVORK
Authorized Official - Middle Name:
Authorized Official - Last Name:BOULATIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-731-4076
Mailing Address - Street 1:17327 VENTURA BLVD STE B-211
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-3906
Mailing Address - Country:US
Mailing Address - Phone:818-731-4076
Mailing Address - Fax:888-512-1287
Practice Address - Street 1:17327 VENTURA BLVD STE B-211
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-3906
Practice Address - Country:US
Practice Address - Phone:818-731-4076
Practice Address - Fax:888-512-1287
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-29
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based