Provider Demographics
NPI:1841406436
Name:SILVER WISDOM ADULT DAY HEALTHCARE CENTER, INC.
Entity Type:Organization
Organization Name:SILVER WISDOM ADULT DAY HEALTHCARE CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:HOVHANNES
Authorized Official - Middle Name:J
Authorized Official - Last Name:OHANIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-464-9161
Mailing Address - Street 1:1714 IVAR AVE
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90028-5124
Mailing Address - Country:US
Mailing Address - Phone:323-464-9161
Mailing Address - Fax:323-464-9166
Practice Address - Street 1:1714 IVAR AVE
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90028-5124
Practice Address - Country:US
Practice Address - Phone:323-464-9161
Practice Address - Fax:323-464-9166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAADU70314FOtherMEDI-CAL PROVIDER NUMBER