Provider Demographics
NPI:1821316076
Name:DEPARTMENT OF VETERANS AFFAIRS OF THE STATE OF CALIFORNIA
Entity Type:Organization
Organization Name:DEPARTMENT OF VETERANS AFFAIRS OF THE STATE OF CALIFORNIA
Other - Org Name:VETERANS HOME OF CALIFORNIA - WEST LOS ANGELES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FINANCE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANI
Authorized Official - Middle Name:
Authorized Official - Last Name:KHACHATOORIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:424-832-8551
Mailing Address - Street 1:PO BOX 942895
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:94295-0001
Mailing Address - Country:US
Mailing Address - Phone:916-657-9349
Mailing Address - Fax:916-653-1795
Practice Address - Street 1:11500 NIMITZ AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90049-3566
Practice Address - Country:US
Practice Address - Phone:818-742-1752
Practice Address - Fax:818-742-1758
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-12
Last Update Date:2020-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA197607966310400000X
CA550002051314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility